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Francisco AA, Foxe JJ, Molholm S. Event-related potential (ERP) markers of 22q11.2 deletion syndrome and associated psychosis. J Neurodev Disord 2023; 15:19. [PMID: 37328766 PMCID: PMC10273715 DOI: 10.1186/s11689-023-09487-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 06/07/2023] [Indexed: 06/18/2023] Open
Abstract
22q11.2 deletion syndrome (22q11.2DS) is a multisystemic disorder characterized by a wide range of clinical features, ranging from life-threatening to less severe conditions. One-third of individuals with the deletion live with mild to moderate intellectual disability; approximately 60% meet criteria for at least one psychiatric condition.22q11.2DS has become an important model for several medical, developmental, and psychiatric disorders. We have been particularly interested in understanding the risk for psychosis in this population: Approximately 30% of the individuals with the deletion go on to develop schizophrenia. The characterization of cognitive and neural differences between those individuals who develop schizophrenia and those who do not, despite being at genetic risk, holds important promise in what pertains to the clarification of paths to disease and to the development of tools for early identification and intervention.Here, we review our previous event-related potential (ERP) findings as potential markers for 22q11.2DS and the associated risk for psychosis, while discussing others' work. We focus on auditory processing (auditory-evoked potentials, auditory adaptation, and auditory sensory memory), visual processing (visual-evoked potentials and visual adaptation), and inhibition and error monitoring.The findings discussed suggest basic mechanistic and disease process effects on neural processing in 22q11.2DS that are present in both early sensory and later cognitive processing, with possible implications for phenotype. In early sensory processes, both during auditory and visual processing, two mechanisms that impact neural responses in opposite ways seem to coexist-one related to the deletion, which increases brain responses; another linked to psychosis, decreasing neural activity. Later, higher-order cognitive processes may be equally relevant as markers for psychosis. More specifically, we argue that components related to error monitoring may hold particular promise in the study of risk for schizophrenia in the general population.
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Affiliation(s)
- Ana A Francisco
- Department of Pediatrics, The Cognitive Neurophysiology Laboratory, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - John J Foxe
- Department of Pediatrics, The Cognitive Neurophysiology Laboratory, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neuroscience, Rose F. Kennedy Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Neuroscience, The Frederick J. and Marion A, Schindler Cognitive Neurophysiology Laboratory, The Ernest J. Del Monde Institute for Neuroscience, University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA
| | - Sophie Molholm
- Department of Pediatrics, The Cognitive Neurophysiology Laboratory, Albert Einstein College of Medicine, Bronx, NY, USA.
- Department of Neuroscience, Rose F. Kennedy Center, Albert Einstein College of Medicine, Bronx, NY, USA.
- Department of Neuroscience, The Frederick J. and Marion A, Schindler Cognitive Neurophysiology Laboratory, The Ernest J. Del Monde Institute for Neuroscience, University of Rochester, School of Medicine and Dentistry, Rochester, NY, USA.
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2
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Schmitt JE, DeBevits JJ, Roalf DR, Ruparel K, Gallagher RS, Gur RC, Alexander-Bloch A, Eom TY, Alam S, Steinberg J, Akers W, Khairy K, Crowley TB, Emanuel B, Zakharenko SS, McDonald-McGinn DM, Gur RE. A Comprehensive Analysis of Cerebellar Volumes in the 22q11.2 Deletion Syndrome. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:79-90. [PMID: 34848384 PMCID: PMC9162086 DOI: 10.1016/j.bpsc.2021.11.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 10/12/2021] [Accepted: 11/08/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND The presence of a 22q11.2 microdeletion (22q11.2 deletion syndrome [22q11DS]) ranks among the greatest known genetic risk factors for the development of psychotic disorders. There is emerging evidence that the cerebellum is important in the pathophysiology of psychosis. However, there is currently limited information on cerebellar neuroanatomy in 22q11DS specifically. METHODS High-resolution 3T magnetic resonance imaging was acquired in 79 individuals with 22q11DS and 70 typically developing control subjects (N = 149). Lobar and lobule-level cerebellar volumes were estimated using validated automated segmentation algorithms, and subsequently group differences were compared. Hierarchical clustering, principal component analysis, and graph theoretical models were used to explore intercerebellar relationships. Cerebrocerebellar structural connectivity with cortical thickness was examined via linear regression models. RESULTS Individuals with 22q11DS had, on average, 17.3% smaller total cerebellar volumes relative to typically developing subjects (p < .0001). The lobules of the superior posterior cerebellum (e.g., VII and VIII) were particularly affected in 22q11DS. However, all cerebellar lobules were significantly smaller, even after adjusting for total brain volumes (all cerebellar lobules p < .0002). The superior posterior lobule was disproportionately associated with cortical thickness in the frontal lobes and cingulate cortex, brain regions known be affected in 22q11DS. Exploratory analyses suggested that the superior posterior lobule, particularly Crus I, may be associated with psychotic symptoms in 22q11DS. CONCLUSIONS The cerebellum is a critical but understudied component of the 22q11DS neuroendophenotype.
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Affiliation(s)
- J Eric Schmitt
- Brain Behavior Laboratory, Neurodevelopment and Psychosis Section, Department of Psychiatry, Philadelphia, Pennsylvania; Division of Neuroradiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
| | - John J DeBevits
- Division of Neuroradiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - David R Roalf
- Brain Behavior Laboratory, Neurodevelopment and Psychosis Section, Department of Psychiatry, Philadelphia, Pennsylvania
| | - Kosha Ruparel
- Brain Behavior Laboratory, Neurodevelopment and Psychosis Section, Department of Psychiatry, Philadelphia, Pennsylvania
| | - R Sean Gallagher
- Brain Behavior Laboratory, Neurodevelopment and Psychosis Section, Department of Psychiatry, Philadelphia, Pennsylvania
| | - Ruben C Gur
- Brain Behavior Laboratory, Neurodevelopment and Psychosis Section, Department of Psychiatry, Philadelphia, Pennsylvania
| | - Aaron Alexander-Bloch
- Brain Behavior Laboratory, Neurodevelopment and Psychosis Section, Department of Psychiatry, Philadelphia, Pennsylvania
| | - Tae-Yeon Eom
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Shahinur Alam
- Center for Bioimage Informatics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jeffrey Steinberg
- Center for Bioimage Informatics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Walter Akers
- Center for Bioimage Informatics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Khaled Khairy
- Center for In Vivo Imaging and Therapeutics, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - T Blaine Crowley
- Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Beverly Emanuel
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Stanislav S Zakharenko
- Department of Developmental Neurobiology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Donna M McDonald-McGinn
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Raquel E Gur
- Brain Behavior Laboratory, Neurodevelopment and Psychosis Section, Department of Psychiatry, Philadelphia, Pennsylvania; Division of Neuroradiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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3
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Piervincenzi C, Fanella M, Petsas N, Frascarelli M, Morano A, Accinni T, Di Fabio F, Di Bonaventura C, Berardelli A, Pantano P. Structural Cerebellar Abnormalities and Parkinsonism in Patients with 22q11.2 Deletion Syndrome. Brain Sci 2022; 12:1533. [PMID: 36421857 PMCID: PMC9688398 DOI: 10.3390/brainsci12111533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 03/23/2024] Open
Abstract
Background: The phenotypic expression of 22q11.2 deletion syndrome (22q11.2DS) is variable and may include cognitive, psychiatric, and neurological manifestations, e.g., parkinsonism. We investigated brain structural alterations in patients with 22q11.2DS with and without parkinsonism (Park+ and Park-) in comparison with healthy controls (HCs). Methods: Voxel-based morphometry was performed on 3D T1-weighted MR images to explore gray matter volume (GMV) differences between 29 patients (15 Park+, 14 Park-), selected from a consecutive series of 56 adults diagnosed with 22q11.2DS, and 24 HCs. One-way ANOVA and multiple linear regression analyses were performed to explore group differences in GMV and correlations between clinical scores (MDS-UPDR-III and MoCA scores) and structural alterations. Results: Significant between-group differences in GMV were found in the cerebellum, specifically in bilateral lobes VIII and left Crus II, as well as in the left superior occipital gyrus. Although both Park+ and Park- patients showed GMV decrements in these regions with respect to HCs, GMV loss in the right lobe VIII and left Crus II was greater in Park+ than in Park- patients. GMV loss did not correlate with clinical scores. Conclusions: Patients with 22q11.2DS and parkinsonism manifest specific cerebellar volume alterations, supporting the hypothesis of neurodegenerative processes in specific cerebellar regions as a putative pathophysiological mechanism responsible for parkinsonism in patients with 22q11.2DS.
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Affiliation(s)
- Claudia Piervincenzi
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Martina Fanella
- Department of Neurology, Fabrizio Spaziani Hospital, 03100 Frosinone, Italy
| | | | - Marianna Frascarelli
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Alessandra Morano
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Tommaso Accinni
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Fabio Di Fabio
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Carlo Di Bonaventura
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
| | - Alfredo Berardelli
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- IRCCS NEUROMED, 86077 Pozzilli, Italy
| | - Patrizia Pantano
- Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy
- IRCCS NEUROMED, 86077 Pozzilli, Italy
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Bagautdinova J, Padula MC, Zöller D, Sandini C, Schneider M, Schaer M, Eliez S. Identifying neurodevelopmental anomalies of white matter microstructure associated with high risk for psychosis in 22q11.2DS. Transl Psychiatry 2020; 10:408. [PMID: 33235187 PMCID: PMC7686319 DOI: 10.1038/s41398-020-01090-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/25/2020] [Accepted: 10/19/2020] [Indexed: 12/11/2022] Open
Abstract
Disruptions of white matter microstructure have been widely reported in schizophrenia. However, the emergence of these alterations during preclinical stages remains poorly understood. 22q11.2 Deletion Syndrome (22q11.2DS) represents a unique model to study the interplay of different risk factors that may impact neurodevelopment in premorbid psychosis. To identify the impact of genetic predisposition for psychosis on white matter development, we acquired longitudinal MRI data in 201 individuals (22q11.2DS = 101; controls = 100) aged 5-35 years with 1-3 time points and reconstructed 18 white matter tracts using TRACULA. Mixed model regression was used to characterize developmental trajectories of four diffusion measures-fractional anisotropy (FA), axial (AD), radial (RD), and mean diffusivity (MD) in each tract. To disentangle the impact of additional environmental and developmental risk factors on white matter maturation, we used a multivariate approach (partial least squares (PLS) correlation) in a subset of 39 individuals with 22q11.2DS. Results revealed no divergent white matter developmental trajectories in patients with 22q11.2DS compared to controls. However, 22q11.2DS showed consistently increased FA and reduced AD, RD, and MD in most white matter tracts. PLS correlation further revealed a significant white matter-clinical risk factors relationship. These results indicate that while age-related changes are preserved in 22q11.2DS, white matter microstructure is widely disrupted, suggesting that genetic high risk for psychosis involves early occurring neurodevelopmental insults. In addition, multivariate modeling showed that clinical risk factors further impact white matter development. Together, these findings suggest that genetic, developmental, and environmental risk factors may play a cumulative role in altering normative white matter development during premorbid stages of psychosis.
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Affiliation(s)
- Joëlle Bagautdinova
- Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland.
| | - Maria C Padula
- Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland
| | - Daniela Zöller
- Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland
- Medical Image Processing Laboratory, Institute of Bioengineering, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
- Department of Radiology and Medical Informatics, University of Geneva, Geneva, Switzerland
- Institute of Neuromodulation and Neurotechnology, Department of Neurosurgery and Neurotechnology, University of Tübingen, Tübingen, Germany
| | - Corrado Sandini
- Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland
| | - Maude Schneider
- Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland
- Clinical Psychology Unit for Intellectual and Developmental Disabilities, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Marie Schaer
- Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland
| | - Stephan Eliez
- Developmental Imaging and Psychopathology Laboratory, University of Geneva School of Medicine, Geneva, Switzerland
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5
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Seese RR. Working Memory Impairments in Cerebellar Disorders of Childhood. Pediatr Neurol 2020; 107:16-23. [PMID: 32276741 DOI: 10.1016/j.pediatrneurol.2020.02.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 01/17/2020] [Accepted: 02/19/2020] [Indexed: 12/20/2022]
Abstract
The cerebellum is a crucial center for motor control and integration. Increasing evidence supports the notion that the cerebellum is also involved in nonmotor functions. Along these lines, multiple cerebellar disorders of childhood and adulthood are associated with behavioral and cognitive symptoms, including impairments in memory. One form of memory commonly affected in cerebellar disorders is working memory, which uses attention to manipulate information that is immediately available to execute cognitive tasks. This article reviews the literature illustrating that working memory impairments are frequently observed in acquired, congenital, and genetic/developmental cerebellar disorders of childhood. Functional neuroimaging studies demonstrate that working memory tasks engage many posterior regions of the cerebellar hemispheres and vermis. Thus, the cerebellum acts as one important node in the working memory circuit, and when the cerebellum is involved in childhood disorders, deficits in working memory commonly occur.
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Affiliation(s)
- Ronald R Seese
- Division of Child Neurology, Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
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6
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Haenssler AE, Baylis A, Perry JL, Kollara L, Fang X, Kirschner R. Impact of Cranial Base Abnormalities on Cerebellar Volume and the Velopharynx in 22q11.2 Deletion Syndrome. Cleft Palate Craniofac J 2020; 57:412-419. [PMID: 31505935 DOI: 10.1177/1055665619874175] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The purpose of this study was to analyze the relationship between cranial base, cerebellar, craniofacial, and velopharyngeal (VP) variables in individuals with 22q11.2 deletion syndrome (22q11DS). METHODS Thirteen typically developing healthy children and 13 age- and sex-matched individuals with 22q11DS completed a magnetic resonance imaging scan, which was used to examine craniofacial and VP variables. RESULTS A statistically significant difference was noted in cerebellum volumes, F1,24 = 7.947, P = .010, posterior nasal spine to posterior pharyngeal wall (PNS-PPW), F1,24 = 4.878, P = .037, nasion-sella-basion (NSB) cranial base angles, F1,24 = 7.253, P = .013, and sella-basion-opisthion (SBO) cranial base angles, F1,24 = 9.134, P = .006, between children with 22q11DS and controls. The cerebellum volume was significantly reduced and cranial base angles were significantly more obtuse in individuals with 22q11DS. In the 22q11DS group, cerebellum volume was significantly correlated with sella-basion (SB) length, osseous pharyngeal depth, the PNS-PPW length, and velar length (P < .05). The PNS-PPW length was correlated with SB length, basion-opisthion length, NSB angle, SBO angle, and the VP ratio (P < .05). CONCLUSION This study supports previous findings on anatomical differences among individuals with 22q11DS and has expanded our current understanding of the potential relationship between craniofacial and VP variables in at least a subset of children with 22q11DS. Results provide preliminary insights into the potential relationship between a decrease in cerebellar volume, obtuse cranial base angles, and unfavorable VP dimensions.
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Affiliation(s)
- Abigail E Haenssler
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - Adriane Baylis
- Nationwide Children's Hospital, Columbus, OH, USA
- The Department of Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Jamie L Perry
- Department of Communication Sciences and Disorders, East Carolina University, Greenville, NC, USA
| | - Lakshmi Kollara
- Department of Clinical Health Sciences, Texas A&M University, Kingsville, TX, USA
| | - Xiangming Fang
- Department of Biostatistics, East Carolina University, Greenville, NC, USA
| | - Richard Kirschner
- Nationwide Children's Hospital, Columbus, OH, USA
- The Department of Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
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7
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van Duin EDA, Ceccarini J, Booij J, Kasanova Z, Vingerhoets C, van Huijstee J, Heinzel A, Mohammadkhani-Shali S, Winz O, Mottaghy F, Myin-Germeys I, van Amelsvoort T. Lower [ 18F]fallypride binding to dopamine D 2/3 receptors in frontal brain areas in adults with 22q11.2 deletion syndrome: a positron emission tomography study. Psychol Med 2020; 50:799-807. [PMID: 30935427 PMCID: PMC7168654 DOI: 10.1017/s003329171900062x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 08/06/2018] [Accepted: 03/05/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND The 22q11.2 deletion syndrome (22q11DS) is caused by a deletion on chromosome 22 locus q11.2. This copy number variant results in haplo-insufficiency of the catechol-O-methyltransferase (COMT) gene, and is associated with a significant increase in the risk for developing cognitive impairments and psychosis. The COMT gene encodes an enzyme that primarily modulates clearance of dopamine (DA) from the synaptic cleft, especially in the prefrontal cortical areas. Consequently, extracellular DA levels may be increased in prefrontal brain areas in 22q11DS, which may underlie the well-documented susceptibility for cognitive impairments and psychosis in affected individuals. This study aims to examine DA D2/3 receptor binding in frontal brain regions in adults with 22q11DS, as a proxy of frontal DA levels. METHODS The study was performed in 14 non-psychotic, relatively high functioning adults with 22q11DS and 16 age- and gender-matched healthy controls (HCs), who underwent DA D2/3 receptor [18F]fallypride PET imaging. Frontal binding potential (BPND) was used as the main outcome measure. RESULTS BPND was significantly lower in adults with 22q11DS compared with HCs in the prefrontal cortex and the anterior cingulate gyrus. After Bonferroni correction significance remained for the anterior cingulate gyrus. There were no between-group differences in BPND in the orbitofrontal cortex and anterior cingulate cortex. CONCLUSIONS This study is the first to demonstrate lower frontal D2/3 receptor binding in adults with 22q11DS. It suggests that a 22q11.2 deletion affects frontal dopaminergic neurotransmission.
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Affiliation(s)
- Esther D. A. van Duin
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Jenny Ceccarini
- Department of Nuclear Medicine and Molecular Imaging, Division of Imaging and Pathology, University Hospital Leuven, KU Leuven, Belgium
| | - Jan Booij
- Academic Medical Center, Amsterdam, The Netherlands
| | - Zuzana Kasanova
- Department of Neuroscience, Center for Contextual Psychiatry, KU Leuven – Leuven University, Leuven, Belgium
| | - Claudia Vingerhoets
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
- Academic Medical Center, Amsterdam, The Netherlands
| | - Jytte van Huijstee
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
| | - Alexander Heinzel
- Department of Nuclear Medicine, University Hospital RWTH, Aachen University, Aachen, Germany
| | | | - Oliver Winz
- Department of Nuclear Medicine, University Hospital RWTH, Aachen University, Aachen, Germany
| | - Felix Mottaghy
- Department of Nuclear Medicine, University Hospital RWTH, Aachen University, Aachen, Germany
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center (MUMC+), Maastricht, The Netherland
| | - Inez Myin-Germeys
- Department of Neuroscience, Center for Contextual Psychiatry, KU Leuven – Leuven University, Leuven, Belgium
| | - Thérèse van Amelsvoort
- Department of Psychiatry & Neuropsychology, Maastricht University, Maastricht, The Netherlands
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Rogdaki M, Gudbrandsen M, McCutcheon RA, Blackmore CE, Brugger S, Ecker C, Craig MC, Daly E, Murphy DGM, Howes O. Magnitude and heterogeneity of brain structural abnormalities in 22q11.2 deletion syndrome: a meta-analysis. Mol Psychiatry 2020; 25:1704-1717. [PMID: 31925327 PMCID: PMC7387301 DOI: 10.1038/s41380-019-0638-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 12/02/2019] [Accepted: 12/12/2019] [Indexed: 12/23/2022]
Abstract
The 22q11.2 deletion syndrome (22q11.2DS) is a neurodevelopmental disorder associated with a number of volumetric brain abnormalities. The syndrome is also associated with an increased risk for neuropsychiatric disorders including schizophrenia and autism spectrum disorder. An earlier meta-analysis showed reduced grey and white matter volumes in individuals with 22q11.2DS. Since this analysis was conducted, the number of studies has increased markedly, permitting more precise estimates of effects and more regions to be examined. Although 22q11.2DS is clinically heterogeneous, it is not known to what extent this heterogeneity is mirrored in neuroanatomy. The aim of this study was thus to investigate differences in mean brain volume and structural variability within regions, between 22q11.2DS and typically developing controls. We examined studies that reported measures of brain volume using MRI in PubMed, Web of Science, Scopus and PsycINFO from inception to 1 May 2019. Data were extracted from studies in order to calculate effect sizes representing case-control difference in mean volume, and in the variability of volume (as measured using the log variability ratio (lnVR) and coefficient of variation ratio (CVR)). We found significant overall decreases in mean volume in 22q11.2DS compared with control for: total brain (g = -0.96; p < 0.001); total grey matter (g = -0.81, p < 0.001); and total white matter (g = -0.81; p < 0.001). There was also a significant overall reduction of mean volume in 22q11.2DS subjects compared with controls in frontal lobe (g = -0.47; p < 0.001), temporal lobe (g = -0.84; p < 0.001), parietal lobe (g = -0.73; p = 0.053), cerebellum (g = -1.25; p < 0.001) and hippocampus (g = -0.90; p < 0.001). Significantly increased variability in 22q11.2DS individuals compared with controls was found only for the hippocampus (VR, 1.14; p = 0.036; CVR, 1.30; p < 0.001), and lateral ventricles (VR, 1.56; p = 0.004). The results support the notion that structural abnormalities in 22q11.2DS and schizophrenia are convergent, and also to some degree with findings in autism spectrum disorder. Finally, the increased variability seen in the hippocampus in 22q11.2DS may underlie some of the heterogeneity observed in the neuropsychiatric phenotype.
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Affiliation(s)
- Maria Rogdaki
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK. .,Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Imperial College, London, W12 0NN, UK.
| | - Maria Gudbrandsen
- 0000 0001 2322 6764grid.13097.3cDepartment of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, SE5 8AF UK
| | - Robert A McCutcheon
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF UK
| | - Charlotte E Blackmore
- 0000 0001 2322 6764grid.13097.3cDepartment of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, SE5 8AF UK
| | - Stefan Brugger
- 0000 0001 2113 8111grid.7445.2Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Imperial College, London, W12 0NN UK ,0000 0001 0807 5670grid.5600.3Cardiff University Brain Research Imaging Centre, School of Psychology, Cardiff University, Cardiff, Wales CF24 4HQ UK ,0000000121901201grid.83440.3bDivision of Psychiatry, UCL, Maple House, London, W1T 7NF UK
| | - Christine Ecker
- 0000 0001 2322 6764grid.13097.3cDepartment of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, SE5 8AF UK ,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Frankfurt am Main, Goethe-University Frankfurt am Main, Frankfurt, Germany
| | - Michael C Craig
- 0000 0001 2322 6764grid.13097.3cDepartment of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, SE5 8AF UK ,0000 0001 2324 5535grid.415717.1National Autism Unit, Bethlem Royal Hospital, London, UK
| | - Eileen Daly
- 0000 0001 2322 6764grid.13097.3cDepartment of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, SE5 8AF UK
| | - Declan G M Murphy
- 0000 0001 2322 6764grid.13097.3cDepartment of Forensic and Neurodevelopmental Sciences, and the Sackler Institute for Translational Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King’s College, London, SE5 8AF UK ,0000 0001 2322 6764grid.13097.3cMRC Centre for Neurodevelopmental Disorders, King’s College London, London, UK
| | - Oliver Howes
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, SE5 8AF UK ,0000 0001 2113 8111grid.7445.2Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Imperial College, London, W12 0NN UK
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Systematic review and multi-modal meta-analysis of magnetic resonance imaging findings in 22q11.2 deletion syndrome: Is more evidence needed? Neurosci Biobehav Rev 2019; 107:143-153. [DOI: 10.1016/j.neubiorev.2019.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 08/07/2019] [Accepted: 09/02/2019] [Indexed: 11/20/2022]
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10
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Leleu A, Favre E, Yailian A, Fumat H, Klamm J, Amado I, Baudouin JY, Franck N, Demily C. An implicit and reliable neural measure quantifying impaired visual coding of facial expression: evidence from the 22q11.2 deletion syndrome. Transl Psychiatry 2019; 9:67. [PMID: 30718458 PMCID: PMC6362075 DOI: 10.1038/s41398-019-0411-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 12/26/2018] [Accepted: 01/17/2019] [Indexed: 11/22/2022] Open
Abstract
Although various psychiatric disorders present with social-cognitive impairment, a measure assessing social-cognitive processes implicitly and reliably, with high selectivity and with enough signal-to-noise ratio (SNR) for individual evaluation of any population at any age, is lacking. Here we isolate a neural marker quantifying impaired visual coding of facial expression in individuals with 22q11.2 deletion syndrome (22q11DS) using frequency-tagging with electroencephalography (EEG). Twenty-two 22q11DS participants and 22 healthy controls were presented with changes of facial expression displayed at low, moderate, and high intensities every five cycles in a stream of one neutral face repeating 6 times per second (i.e., at a 6 Hz base rate). The brain response to expression changes tagged at the 1.2 Hz (i.e., 6 Hz/5) predefined frequency was isolated over occipito-temporal regions in both groups of participants for moderate- and high-intensity facial expressions. Neural sensitivity to facial expression was reduced by about 36% in 22q11DS, revealing impaired visual coding of emotional facial signals. The significance of the expression-change response was estimated for each single participant thanks to the high SNR of the approach. Further analyses revealed the high reliability of the response and its immunity from other neurocognitive skills. Interestingly, response magnitude was associated with the severity of positive symptoms, pointing to a potential endophenotype for psychosis risk. Overall, the present study reveals an objective, selective, reliable, and behavior-free signature of impaired visual coding of facial expression implicitly quantified from brain activity with high SNR. This novel tool opens avenues for clinical practice, providing a potential early biomarker for later psychosis onset and offering an alternative for individual assessment of social-cognitive functioning in even difficult-to-test participants.
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Affiliation(s)
- Arnaud Leleu
- Developmental Ethology and Cognitive Psychology group, Centre des Sciences du Goût et de l'Alimentation, CNRS, Université Bourgogne Franche-Comté, Inra, AgroSup Dijon, F-21000, Dijon, France.
| | - Emilie Favre
- Reference Center for Rare Diseases with Psychiatric Phenotype - GénoPsy, Centre Hospitalier le Vinatier, Marc Jeannerod Institute (CNRS & Claude Bernard Lyon 1 University), Bron, France
| | - Alexandre Yailian
- Child and Adolescent Psychiatry, University Hospital of Montpellier, University Montpellier 1, Montpellier, France
| | - Hugo Fumat
- Reference Center for Rare Diseases with Psychiatric Phenotype - GénoPsy, Centre Hospitalier le Vinatier, Marc Jeannerod Institute (CNRS & Claude Bernard Lyon 1 University), Bron, France
| | - Juliette Klamm
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Centre Hospitalier Le Vinatier & Université Lyon 1 (CNRS UMR 5229), Université de Lyon, Lyon, France
| | - Isabelle Amado
- Centre Ressource Ile de France de Remédiation Cognitive et Réhabilitation Psychosociale, Groupe Hospitalier Universitaire, Institut de Psychiatrie et Neurosciences de Paris, Université Paris Descartes, Paris, France
| | - Jean-Yves Baudouin
- Developmental Ethology and Cognitive Psychology group, Centre des Sciences du Goût et de l'Alimentation, CNRS, Université Bourgogne Franche-Comté, Inra, AgroSup Dijon, F-21000, Dijon, France
- Laboratoire Développement, Individu, Processus, Handicap, Éducation (DIPHE), Département Psychologie du Développement, de l'Éducation et des Vulnérabilités (PsyDEV), Institut de Psychologie, Université de Lyon (Lumière Lyon 2), 69676, Bron Cedex, France
| | - Nicolas Franck
- Centre Ressource de Réhabilitation Psychosociale et de Remédiation Cognitive, Centre Hospitalier Le Vinatier & Université Lyon 1 (CNRS UMR 5229), Université de Lyon, Lyon, France
| | - Caroline Demily
- Reference Center for Rare Diseases with Psychiatric Phenotype - GénoPsy, Centre Hospitalier le Vinatier, Marc Jeannerod Institute (CNRS & Claude Bernard Lyon 1 University), Bron, France.
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11
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Moberg PJ, Richman MJ, Roalf DR, Morse CL, Graefe AC, Brennan L, Vickers K, Tsering W, Kamath V, Turetsky BI, Gur RC, Gur RE. Neurocognitive Functioning in Patients with 22q11.2 Deletion Syndrome: A Meta-Analytic Review. Behav Genet 2018; 48:259-270. [PMID: 29922984 DOI: 10.1007/s10519-018-9903-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 05/14/2018] [Indexed: 11/27/2022]
Abstract
The 22q11.2 deletion syndrome (22q11.2DS) is a known risk factor for development of schizophrenia and is characterized by a complex neuropsychological profile. To date, a quantitative meta-analysis examining cognitive functioning in 22q11.2DS has not been conducted. A systematic review of cross-sectional studies comparing neuropsychological performance of individuals with 22q11.2DS with age-matched healthy typically developing and sibling comparison subjects was carried out. Potential moderators were analyzed. Analyses included 43 articles (282 effects) that met inclusion criteria. Very large and heterogeneous effects were seen for global cognition (d = - 1.21) and in specific neuropsychological domains (intellectual functioning, achievement, and executive function; d range = - 0.51 to - 2.43). Moderator analysis revealed a significant role for type of healthy comparison group used (typically developing or siblings), demographics (age, sex) and clinical factors (externalizing behavior). Results revealed significant differences between pediatric and adult samples, with isolated analysis within the pediatric sample yielding large effects in several neuropsychological domains (intellectual functioning, achievement, visual memory; d range = - 0.56 to - 2.50). Large cognitive deficits in intellectual functioning and specific neuropsychological variables in individuals with 22q11.2DS represent a robust finding, but these deficits are influenced by several factors, including type of comparison group utilized, age, sex, and clinical status. These findings highlight the clinical relevance of characterizing cognitive functioning in 22q11.2DS and the importance of considering demographic and clinical moderators in future analyses.
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Affiliation(s)
- Paul J Moberg
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA. .,Neuropsychiatry Section, Department of Psychiatry, Hospital of The University of Pennsylvania, 10th Floor, Gates Pavilion, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Mara J Richman
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Clinical Psychology and Addictology, Eötvös Loránd University, Budapest, Hungary
| | - David R Roalf
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Chelsea L Morse
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Anna C Graefe
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Laura Brennan
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Neurology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Kayci Vickers
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Psychology, Drexel University, Philadelphia, PA, USA
| | - Wangchen Tsering
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Earlham College, Richmond, IN, USA
| | - Vidyulata Kamath
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Bruce I Turetsky
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ruben C Gur
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Lifespan Brain Institute (LiBI), University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Lifespan Brain Institute (LiBI), University of Pennsylvania and Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.,Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
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12
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Abstract
Recent large-scale genomic studies have confirmed that schizophrenia is a polygenic syndrome and have implicated a number of biological pathways in its aetiology. Both common variants individually of small effect and rarer but more penetrant genetic variants have been shown to play a role in the pathogenesis of the disorder. No simple Mendelian forms of the condition have been identified, but progress has been made in stratifying risk on the basis of the polygenic burden of common variants individually of small effect, and the contribution of rarer variants of larger effect such as Copy Number Variants (CNVs). Pathway analysis of risk-associated variants has begun to identify specific biological processes implicated in risk for the disorder, including elements of the glutamatergic NMDA receptor complex and post synaptic density, voltage-gated calcium channels, targets of the Fragile X Mental Retardation Protein (FMRP targets) and immune pathways. Genetic studies have also been used to drive genomic imaging approaches to the investigation of brain markers associated with risk for the disorder. Genomic imaging approaches have been applied both to investigate the effect of polygenic risk and to study the impact of individual higher-penetrance variants such as CNVs. Both genomic and genomic imaging approaches offer potential for the stratification of patients and at-risk groups and the development of better biomarkers of risk and treatment response; however, further research is needed to integrate this work and realise the full potential of these approaches.
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13
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Zhan L, Jenkins LM, Zhang A, Conte G, Forbes A, Harvey D, Angkustsiri K, Goodrich‐Hunsaker NJ, Durdle C, Lee A, Schumann C, Carmichael O, Kalish K, Leow AD, Simon TJ. Baseline connectome modular abnormalities in the childhood phase of a longitudinal study on individuals with chromosome 22q11.2 deletion syndrome. Hum Brain Mapp 2018; 39:232-248. [PMID: 28990258 PMCID: PMC5757536 DOI: 10.1002/hbm.23838] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 09/20/2017] [Accepted: 09/27/2017] [Indexed: 01/09/2023] Open
Abstract
Occurring in at least 1 in 3,000 live births, chromosome 22q11.2 deletion syndrome (22q11DS) produces a complex phenotype that includes a constellation of medical complications such as congenital cardiac defects, immune deficiency, velopharyngeal dysfunction, and characteristic facial dysmorphic features. There is also an increased incidence of psychiatric diagnosis, especially intellectual disability and ADHD in childhood, lifelong anxiety, and a strikingly high rate of schizophrenia spectrum disorders, which occur in around 30% of adults with 22q11DS. Using innovative computational connectomics, we studied how 22q11DS affects high-level network signatures of hierarchical modularity and its intrinsic geometry in 55 children with confirmed 22q11DS and 27 Typically Developing (TD) children. Results identified 3 subgroups within our 22q11DS sample using a K-means clustering approach based on several midline structural measures-of-interests. Each subgroup exhibited distinct patterns of connectome abnormalities. Subtype 1, containing individuals with generally healthy-looking brains, exhibited no significant differences in either modularity or intrinsic geometry when compared with TD. By contrast, the more anomalous 22q11DS Subtypes 2 and 3 brains revealed significant modular differences in the right hemisphere, while Subtype 3 (the most anomalous anatomy) further exhibited significantly abnormal connectome intrinsic geometry in the form of left-right temporal disintegration. Taken together, our findings supported an overall picture of (a) anterior-posteriorly differential interlobar frontotemporal/frontoparietal dysconnectivity in Subtypes 2 and 3 and (b) differential intralobar dysconnectivity in Subtype 3. Our ongoing studies are focusing on whether these subtypes and their connnectome signatures might be valid biomarkers for predicting the degree of psychosis-proneness risk found in 22q11DS. Hum Brain Mapp 39:232-248, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Liang Zhan
- Computer Engineering ProgramUniversity of Wisconsin‐StoutWisconsin
| | | | - Aifeng Zhang
- Department of PsychiatryUniversity of IllinoisChicagoIllinois
| | - Giorgio Conte
- Department of Computer ScienceUniversity of IllinoisChicagoIllinois
| | - Angus Forbes
- Department of Computer ScienceUniversity of IllinoisChicagoIllinois
| | - Danielle Harvey
- Division of Biostatistics, Department of Public Health Sciences, School of MedicineUniversity of CaliforniaDavisCalifornia
| | | | - Naomi J. Goodrich‐Hunsaker
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaDavisCalifornia
- Department of PsychologyBrigham Young UniversityProvoUtah
| | - Courtney Durdle
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaDavisCalifornia
| | - Aaron Lee
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaDavisCalifornia
| | - Cyndi Schumann
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaDavisCalifornia
| | - Owen Carmichael
- Pennington Biomedical Research Center, Louisiana State UniversityBaton RougeLouisiana
| | | | - Alex D. Leow
- Department of PsychiatryUniversity of IllinoisChicagoIllinois
- Department of BioengineeringUniversity of IllinoisChicagoIllinois
| | - Tony J. Simon
- Department of Psychiatry and Behavioral SciencesUniversity of CaliforniaDavisCalifornia
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14
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Cunningham AC, Delport S, Cumines W, Busse M, Linden DEJ, Hall J, Owen MJ, van den Bree MBM. Developmental coordination disorder, psychopathology and IQ in 22q11.2 deletion syndrome. Br J Psychiatry 2018; 212:27-33. [PMID: 29433607 PMCID: PMC6457162 DOI: 10.1192/bjp.2017.6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 07/25/2017] [Accepted: 09/22/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND 22q11.2 deletion syndrome (22q11.2DS) is associated with high rates of neurodevelopmental disorder, however, the links between developmental coordination disorder (DCD), intellectual function and psychiatric disorder remain unexplored. Aims To establish the prevalence of indicative DCD in children with 22q11.2DS and examine associations with IQ, neurocognition and psychopathology. METHOD Neurocognitive assessments and psychiatric interviews of 70 children with 22q11.2DS (mean age 11.2, s.d. = 2.2) and 32 control siblings (mean age 11.5, s.d. = 2.1) were carried out in their homes. Nine children with 22q11.2DS and indicative DCD were subsequently assessed in an occupational therapy clinic. RESULTS Indicative DCD was found in 57 (81.4%) children with 22q11.2DS compared with 2 (6.3%) control siblings (odds ratio (OR) = 36.7, P < 0.001). Eight of nine (89%) children with indicative DCD met DSM-5 criteria for DCD. Poorer coordination was associated with increased numbers of anxiety, (P < 0.001), attention-deficit hyperactivity disorder (ADHD) (P < 0.001) and autism-spectrum disorder (ASD) symptoms (P < 0.001) in children with 22q11.2DS. Furthermore, 100% of children with 22q11.2DS and ADHD had indicative DCD (20 of 20), as did 90% of children with anxiety disorder (17 of 19) and 96% of children who screened positive for ASD (22 of 23). The Developmental Coordination Disorder Questionnaire score was related to sustained attention (P = 0.006), even after history of epileptic fits (P = 0.006) and heart problems (P = 0.009) was taken into account. CONCLUSIONS Clinicians should be aware of the high risk of coordination difficulties in children with 22q11.2DS and its association with risk of mental disorder and specific neurocognitive deficits. Declaration of interest None.
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Affiliation(s)
- Adam C. Cunningham
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Sue Delport
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Wendy Cumines
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Monica Busse
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - David E. J. Linden
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Jeremy Hall
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Michael J. Owen
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
| | - Marianne B. M. van den Bree
- MRC Centre for Neuropsychiatric Genetics and Genomics, Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, UK
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15
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Bohm LA, Zhou TC, Mingo TJ, Dugan SL, Patterson RJ, Sidman JD, Roby BB. Neuroradiographic findings in 22q11.2 deletion syndrome. Am J Med Genet A 2017; 173:2158-2165. [PMID: 28577347 DOI: 10.1002/ajmg.a.38304] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/20/2017] [Accepted: 05/10/2017] [Indexed: 10/19/2022]
Abstract
22q11.2 deletion syndrome (22q11.2DS) is a common genetic disorder with enormous phenotypic heterogeneity. Despite the established prevalence of developmental and neuropsychiatric issues in this syndrome, its neuroanatomical correlates are not as well understood. A retrospective chart review was performed on 111 patients diagnosed with 22q11.2DS. Of the 111 patients, 24 with genetically confirmed 22q11.2 deletion and brain MRI or MRA were included in this study. The most common indications for imaging were unexplained developmental delay (6/24), seizures of unknown etiology (5/24), and unilateral weakness (3/24). More than half (13/24) of the patients had significant radiographic findings, including persistent cavum septi pellucidi and/or cavum vergae (8/24), aberrant cortical veins (6/24), polymicrogyria or cortical dysplasia (4/24), inner ear deformities (3/24), hypoplastic internal carotid artery (2/24), and hypoplastic cerebellum (1/24). These findings reveal the types and frequencies of brain malformations in this case series, and suggest that the prevalence of neuroanatomical abnormalities in 22q11.2DS may be underestimated. Understanding indications for imaging and frequently encountered brain malformations will result in early diagnosis and intervention in an effort to optimize patient outcomes.
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Affiliation(s)
- Lauren A Bohm
- University of Minnesota, Minneapolis, Minnesota.,ENT and Facial Plastic Surgery, Children's Minnesota, Children's Specialty Center, Minneapolis, Minnesota.,Division of Pediatric Otolaryngology, University of Michigan, Ann Arbor, Michigan
| | - Tom C Zhou
- University of Minnesota, Minneapolis, Minnesota
| | | | - Sarah L Dugan
- Medical Genetics, Children's Minnesota, Minneapolis, Minnesota.,Division of Pediatric Genetics, University of Utah, Salt Lake City, Utah
| | | | - James D Sidman
- University of Minnesota, Minneapolis, Minnesota.,ENT and Facial Plastic Surgery, Children's Minnesota, Children's Specialty Center, Minneapolis, Minnesota
| | - Brianne B Roby
- University of Minnesota, Minneapolis, Minnesota.,ENT and Facial Plastic Surgery, Children's Minnesota, Children's Specialty Center, Minneapolis, Minnesota
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16
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Tylee DS, Kikinis Z, Quinn TP, Antshel KM, Fremont W, Tahir MA, Zhu A, Gong X, Glatt SJ, Coman IL, Shenton ME, Kates WR, Makris N. Machine-learning classification of 22q11.2 deletion syndrome: A diffusion tensor imaging study. NEUROIMAGE-CLINICAL 2017; 15:832-842. [PMID: 28761808 PMCID: PMC5522376 DOI: 10.1016/j.nicl.2017.04.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 03/27/2017] [Accepted: 04/04/2017] [Indexed: 11/27/2022]
Abstract
Chromosome 22q11.2 deletion syndrome (22q11.2DS) is a genetic neurodevelopmental syndrome that has been studied intensively in order to understand relationships between the genetic microdeletion, brain development, cognitive function, and the emergence of psychiatric symptoms. White matter microstructural abnormalities identified using diffusion tensor imaging methods have been reported to affect a variety of neuroanatomical tracts in 22q11.2DS. In the present study, we sought to combine two discovery-based approaches: (1) white matter query language was used to parcellate the brain's white matter into tracts connecting pairs of 34, bilateral cortical regions and (2) the diffusion imaging characteristics of the resulting tracts were analyzed using a machine-learning method called support vector machine in order to optimize the selection of a set of imaging features that maximally discriminated 22q11.2DS and comparison subjects. With this unique approach, we both confirmed previously-recognized 22q11.2DS-related abnormalities in the inferior longitudinal fasciculus (ILF), and identified, for the first time, 22q11.2DS-related anomalies in the middle longitudinal fascicle and the extreme capsule, which may have been overlooked in previous, hypothesis-guided studies. We further observed that, in participants with 22q11.2DS, ILF metrics were significantly associated with positive prodromal symptoms of psychosis.
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Key Words
- (-fp), fronto-parietal aspect
- (-to), temporo-occipital aspect
- (-tp), temporo-parietal aspect
- (22q11.2DS), 22q11.2 deletion syndrome
- (AD), axial diffusivity
- (DTI), diffusion tensor imaging
- (DWI), diffusion weighted image
- (EmC), extreme capsule
- (FA), fractional anisotropy
- (FOV), field of view
- (GDS), Gordon Diagnostic Systems
- (ILF), inferior longitudinal fasciculus
- (MdLF), middle longitudinal fascicle
- (RD), radial diffusivity
- (ROI), region of interest
- (SIPS), Structured Interview for Prodromal Syndromes
- (SRS), Social Responsiveness Scale
- (STG), superior temporal gyrus
- (SVM), support vector machine
- (UKF), Unscented Kalman Filter
- (WAIS-III), Wechsler Adult Intelligence Scale – 3rd edition
- (WMQL), white matter query language
- (dTP), dorsal temporal pole
- 22q11.2 deletion syndrome
- Callosal asymmetry
- Diffusion tensor imaging
- Extreme capsule
- Inferior longitudinal fasciculus
- Machine-learning
- Middle longitudinal fascicle
- Support vector machine
- Velocardiofacial syndrome
- White matter query language
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Affiliation(s)
- Daniel S Tylee
- Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA; Department of Psychiatry and Behavioral Sciences; SUNY Upstate Medical University, Syracuse, NY, USA
| | - Zora Kikinis
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Thomas P Quinn
- Bioinformatics Core Research Group, Deakin University, Geelong, Victoria, Australia
| | | | - Wanda Fremont
- Department of Psychiatry and Behavioral Sciences; SUNY Upstate Medical University, Syracuse, NY, USA.
| | - Muhammad A Tahir
- Department of Psychiatry and Behavioral Sciences; SUNY Upstate Medical University, Syracuse, NY, USA
| | - Anni Zhu
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Xue Gong
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stephen J Glatt
- Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA; Department of Psychiatry and Behavioral Sciences; SUNY Upstate Medical University, Syracuse, NY, USA.
| | - Ioana L Coman
- Department of Psychiatry and Behavioral Sciences; SUNY Upstate Medical University, Syracuse, NY, USA.
| | - Martha E Shenton
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; VA Boston Healthcare System, Harvard Medical School, Brockton, MA, USA.
| | - Wendy R Kates
- Department of Psychiatry and Behavioral Sciences; SUNY Upstate Medical University, Syracuse, NY, USA.
| | - Nikos Makris
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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17
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Persson C, Laakso K, Edwardsson H, Lindblom J, Hartelius L. Signs of dysarthria in adults with 22q11.2 deletion syndrome. Am J Med Genet A 2017; 173:618-626. [DOI: 10.1002/ajmg.a.38038] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/11/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Christina Persson
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Katja Laakso
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Hannah Edwardsson
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Johanna Lindblom
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Lena Hartelius
- Institute of Neuroscience and Physiology, Speech and Language Pathology Unit, Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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18
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Bakker G, Caan MWA, Vingerhoets WAM, da Silva- Alves F, de Koning M, Boot E, Nieman DH, de Haan L, Bloemen OJ, Booij J, van Amelsvoort TAMJ. Cortical Morphology Differences in Subjects at Increased Vulnerability for Developing a Psychotic Disorder: A Comparison between Subjects with Ultra-High Risk and 22q11.2 Deletion Syndrome. PLoS One 2016; 11:e0159928. [PMID: 27828960 PMCID: PMC5102447 DOI: 10.1371/journal.pone.0159928] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Accepted: 07/11/2016] [Indexed: 01/14/2023] Open
Abstract
Introduction Subjects with 22q11.2 deletion syndrome (22q11DS) and subjects with ultra-high risk for psychosis (UHR) share a risk of approximately 30% to develop a psychotic disorder. Studying these groups helps identify biological markers of pathophysiological processes involved in the development of psychosis. Total cortical surface area (cSA), total cortical grey matter volume (cGMV), cortical thickness (CT), and local gyrification index (LGI) of the cortical structure have a distinct neurodevelopmental origin making them important target markers to study in relation to the development of psychosis. Materials and Methods Structural T1-weighted high resolution images were acquired using a 3 Tesla Intera MRI system in 18 UHR subjects, 18 22q11DS subjects, and 24 matched healthy control (HC) subjects. Total cSA, total cGMV, mean CT, and regional vertex-wise differences in CT and LGI were assessed using FreeSurfer software. The Positive and Negative Syndrome Scale was used to assess psychotic symptom severity in UHR and 22q11DS subjects at time of scanning. Results 22q11DS subjects had lower total cSA and total cGMV compared to UHR and HC subjects. The 22q11DS subjects showed bilateral lower LGI in the i) prefrontal cortex, ii) precuneus, iii) precentral gyrus and iv) cuneus compared to UHR subjects. Additionally, lower LGI was found in the left i) fusiform gyrus and right i) pars opercularis, ii) superior, and iii) inferior temporal gyrus in 22q11DS subjects compared to HC. In comparison to 22q11DS subjects, the UHR subjects had lower CT of the insula. For both risk groups, positive symptom severity was negatively correlated to rostral middle frontal gyrus CT. Conclusion A shared negative correlation between positive symptom severity and rostral middle frontal gyrus CT in UHR and 22q11DS may be related to their increased vulnerability to develop a psychotic disorder. 22q11DS subjects were characterised by widespread lower degree of cortical gyrification linked to early and postnatal neurodevelopmental pathology. No implications for early neurodevelopmental pathology were found for the UHR subjects, although they did have distinctively lower insula CT which may have arisen from defective pruning processes during adolescence. Implications of these findings in relation to development of psychotic disorders are in need of further investigation in longitudinal studies.
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Affiliation(s)
- Geor Bakker
- Department of Psychiatry & Psychology, University of Maastricht, Maastricht, The Netherlands
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- * E-mail:
| | - Matthan W. A. Caan
- Department of Radiology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Wilhelmina A. M. Vingerhoets
- Department of Psychiatry & Psychology, University of Maastricht, Maastricht, The Netherlands
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Fabiana da Silva- Alves
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Erik Boot
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- The Dalglish Family 22q Clinic, Toronto, Ontario, Canada
| | - Dorien H. Nieman
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Oswald J. Bloemen
- Department of Psychiatry & Psychology, University of Maastricht, Maastricht, The Netherlands
- GGZ Centraal, Center for Mental Health Care Innova, Amersfoort, The Netherlands
| | - Jan Booij
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Thérèse A. M. J. van Amelsvoort
- Department of Psychiatry & Psychology, University of Maastricht, Maastricht, The Netherlands
- Department of Nuclear Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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19
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McCabe KL, Marlin S, Cooper G, Morris R, Schall U, Murphy DG, Murphy KC, Campbell LE. Visual perception and processing in children with 22q11.2 deletion syndrome: associations with social cognition measures of face identity and emotion recognition. J Neurodev Disord 2016; 8:30. [PMID: 27536336 PMCID: PMC4988033 DOI: 10.1186/s11689-016-9164-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 07/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND People with 22q11.2 deletion syndrome (22q11DS) have difficulty processing social information including facial identity and emotion processing. However, difficulties with visual and attentional processes may play a role in difficulties observed with these social cognitive skills. METHODS A cross-sectional study investigated visual perception and processing as well as facial processing abilities in a group of 49 children and adolescents with 22q11DS and 30 age and socio-economic status-matched healthy sibling controls using the Birmingham Object Recognition Battery and face processing sub-tests from the MRC face processing skills battery. RESULTS The 22q11DS group demonstrated poorer performance on all measures of visual perception and processing, with greatest impairment on perceptual processes relating to form perception as well as object recognition and memory. In addition, form perception was found to make a significant and unique contribution to higher order social-perceptual processing (face identity) in the 22q11DS group. CONCLUSIONS The findings indicate evidence for impaired visual perception and processing capabilities in 22q11DS. In turn, these were found to influence cognitive skills needed for social processes such as facial identity recognition in the children with 22q11DS.
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Affiliation(s)
- Kathryn L McCabe
- Priority Research Centre for Brain and Mental Health Research, The University of Newcastle, Callaghan, Australia ; Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA USA ; Schizophrenia Research Institute, Sydney, Australia
| | - Stuart Marlin
- School of Psychology, University of Newcastle, Callaghan, Australia
| | - Gavin Cooper
- Priority Research Centre for Brain and Mental Health Research, The University of Newcastle, Callaghan, Australia ; Schizophrenia Research Institute, Sydney, Australia
| | - Robin Morris
- King's College Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Ulrich Schall
- Priority Research Centre for Brain and Mental Health Research, The University of Newcastle, Callaghan, Australia ; Schizophrenia Research Institute, Sydney, Australia ; Hunter Medical Research Institute, Newcastle, Australia
| | - Declan G Murphy
- King's College Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Kieran C Murphy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Linda E Campbell
- School of Psychology, University of Newcastle, Callaghan, Australia ; Hunter Medical Research Institute, Newcastle, Australia ; Priority Research Centre GrowUpWell, The University of Newcastle, Callaghan, Australia ; School of Psychology, University of Newcastle, Science Offices, Ourimbah, NSW 2258 Australia
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O'Hanlon E, Howley S, Prasad S, McGrath J, Leemans A, McDonald C, Garavan H, Murphy KC. Multimodal MRI reveals structural connectivity differences in 22q11 deletion syndrome related to impaired spatial working memory. Hum Brain Mapp 2016; 37:4689-4705. [PMID: 27511297 DOI: 10.1002/hbm.23337] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 05/09/2016] [Accepted: 07/25/2016] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Impaired spatial working memory is a core cognitive deficit observed in people with 22q11 Deletion syndrome (22q11DS) and has been suggested as a candidate endophenotype for schizophrenia. However, to date, the neuroanatomical mechanisms describing its structural and functional underpinnings in 22q11DS remain unclear. We quantitatively investigate the cognitive processes and associated neuroanatomy of spatial working memory in people with 22q11DS compared to matched controls. We examine whether there are significant between-group differences in spatial working memory using task related fMRI, Voxel based morphometry and white matter fiber tractography. MATERIALS AND METHODS Multimodal magnetic resonance imaging employing functional, diffusion and volumetric techniques were used to quantitatively assess the cognitive and neuroanatomical features of spatial working memory processes in 22q11DS. Twenty-six participants with genetically confirmed 22q11DS aged between 9 and 52 years and 26 controls aged between 8 and 46 years, matched for age, gender, and handedness were recruited. RESULTS People with 22q11DS have significant differences in spatial working memory functioning accompanied by a gray matter volume reduction in the right precuneus. Gray matter volume was significantly correlated with task performance scores in these areas. Tractography revealed extensive differences along fibers between task-related cortical activations with pronounced differences localized to interhemispheric commissural fibers within the parietal section of the corpus callosum. CONCLUSIONS Abnormal spatial working memory in 22q11DS is associated with aberrant functional activity in conjunction with gray and white matter structural abnormalities. These anomalies in discrete brain regions may increase susceptibility to the development of psychiatric disorders such as schizophrenia. Hum Brain Mapp 37:4689-4705, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Erik O'Hanlon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Educational and Research Centre, Beaumont Hospital, Dublin 9, Ireland.,School of Psychology and Institute of Neuroscience, Trinity College, Dublin 2, Ireland
| | - Sarah Howley
- Department of Psychiatry, Royal College of Surgeons in Ireland, Educational and Research Centre, Beaumont Hospital, Dublin 9, Ireland
| | - Sarah Prasad
- Department of Psychiatry, Royal College of Surgeons in Ireland, Educational and Research Centre, Beaumont Hospital, Dublin 9, Ireland
| | - Jane McGrath
- School of Psychology and Institute of Neuroscience, Trinity College, Dublin 2, Ireland
| | - Alexander Leemans
- Image Sciences Institute, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Colm McDonald
- Department of Psychiatry, National University of Ireland, Galway, Ireland
| | - Hugh Garavan
- School of Psychology and Institute of Neuroscience, Trinity College, Dublin 2, Ireland.,Departments of Psychiatry and Psychology, University of Vermont, Vermont, USA
| | - Kieran C Murphy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Educational and Research Centre, Beaumont Hospital, Dublin 9, Ireland
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21
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van Duin EDA, Goossens L, Hernaus D, da Silva Alves F, Schmitz N, Schruers K, van Amelsvoort T. Neural correlates of reward processing in adults with 22q11 deletion syndrome. J Neurodev Disord 2016; 8:25. [PMID: 27429661 PMCID: PMC4946156 DOI: 10.1186/s11689-016-9158-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 07/05/2016] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND 22q11.2 deletion syndrome (22q11DS) is caused by a microdeletion on chromosome 22q11.2 and associated with an increased risk to develop psychosis. The gene coding for catechol-O-methyl-transferase (COMT) is located at the deleted region, resulting in disrupted dopaminergic neurotransmission in 22q11DS, which may contribute to the increased vulnerability for psychosis. A dysfunctional motivational reward system is considered one of the salient features in psychosis and thought to be related to abnormal dopaminergic neurotransmission. The functional anatomy of the brain reward circuitry has not yet been investigated in 22q11DS. METHODS This study aims to investigate neural activity during anticipation of reward and loss in adult patients with 22q11DS. We measured blood-oxygen-level dependent (BOLD) activity in 16 patients with 22q11DS and 12 healthy controls during a monetary incentive delay task using a 3T Philips Intera MRI system. Data were analysed using SPM8. RESULTS During anticipation of reward, the 22q11DS group alone displayed significant activation in bilateral middle frontal and temporal brain regions. Compared to healthy controls, significantly less activation in bilateral cingulate gyrus extending to premotor, primary motor and somatosensory areas was found. During anticipation of loss, the 22q11DS group displayed activity in the left middle frontal gyrus and anterior cingulate cortex, and relative to controls, they showed reduced brain activation in bilateral (pre)cuneus and left posterior cingulate. Within the 22q11DS group, COMT Val hemizygotes displayed more activation compared to Met hemizygotes in right posterior cingulate and bilateral parietal regions during anticipation of reward. During anticipation of loss, COMT Met hemizygotes compared to Val hemizygotes showed more activation in bilateral insula, striatum and left anterior cingulate. CONCLUSIONS This is the first study to investigate reward processing in 22q11DS. Our preliminary results suggest that people with 22q11DS engage a fronto-temporal neural network. Compared to healthy controls, people with 22q11DS primarily displayed reduced activity in medial frontal regions during reward anticipation. COMT hemizygosity affects responsivity of the reward system in this condition. Alterations in reward processing partly underlain by the dopamine system may play a role in susceptibility for psychosis in 22q11DS.
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Affiliation(s)
- Esther D. A. van Duin
- />Department of Psychiatry and Psychology, Maastricht University, Maastricht, The Netherlands
| | - Liesbet Goossens
- />Department of Psychiatry and Psychology, Maastricht University, Maastricht, The Netherlands
| | - Dennis Hernaus
- />Department of Psychiatry and Psychology, Maastricht University, Maastricht, The Netherlands
| | - Fabiana da Silva Alves
- />Department of Psychiatry, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Nicole Schmitz
- />Department of Psychiatry, Academic Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Koen Schruers
- />Department of Psychiatry and Psychology, Maastricht University, Maastricht, The Netherlands
| | - Therese van Amelsvoort
- />Department of Psychiatry and Psychology, Maastricht University, Maastricht, The Netherlands
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22
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Facial emotion perception by intensity in children and adolescents with 22q11.2 deletion syndrome. Eur Child Adolesc Psychiatry 2016; 25:297-310. [PMID: 26149605 DOI: 10.1007/s00787-015-0741-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 06/25/2015] [Indexed: 10/23/2022]
Abstract
Difficulties in the recognition of emotions in expressive faces have been reported in people with 22q11.2 deletion syndrome (22q11.2DS). However, while low-intensity expressive faces are frequent in everyday life, nothing is known about their ability to perceive facial emotions depending on the intensity of expression. Through a visual matching task, children and adolescents with 22q11.2DS as well as gender- and age-matched healthy participants were asked to categorise the emotion of a target face among six possible expressions. Static pictures of morphs between neutrality and expressions were used to parametrically manipulate the intensity of the target face. In comparison to healthy controls, results showed higher perception thresholds (i.e. a more intense expression is needed to perceive the emotion) and lower accuracy for the most expressive faces indicating reduced categorisation abilities in the 22q11.2DS group. The number of intrusions (i.e. each time an emotion is perceived as another one) and a more gradual perception performance indicated smooth boundaries between emotional categories. Correlational analyses with neuropsychological and clinical measures suggested that reduced visual skills may be associated with impaired categorisation of facial emotions. Overall, the present study indicates greater difficulties for children and adolescents with 22q11.2DS to perceive an emotion in low-intensity expressive faces. This disability is subtended by emotional categories that are not sharply organised. It also suggests that these difficulties may be associated with impaired visual cognition, a hallmark of the cognitive deficits observed in the syndrome. These data yield promising tracks for future experimental and clinical investigations.
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Váša F, Griffa A, Scariati E, Schaer M, Urben S, Eliez S, Hagmann P. An affected core drives network integration deficits of the structural connectome in 22q11.2 deletion syndrome. NEUROIMAGE-CLINICAL 2015; 10:239-49. [PMID: 26870660 PMCID: PMC4711395 DOI: 10.1016/j.nicl.2015.11.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 11/06/2015] [Accepted: 11/24/2015] [Indexed: 01/01/2023]
Abstract
Chromosome 22q11.2 deletion syndrome (22q11DS) is a genetic disease known to lead to cerebral structural alterations, which we study using the framework of the macroscopic white-matter connectome. We create weighted connectomes of 44 patients with 22q11DS and 44 healthy controls using diffusion tensor magnetic resonance imaging, and perform a weighted graph theoretical analysis. After confirming global network integration deficits in 22q11DS (previously identified using binary connectomes), we identify the spatial distribution of regions responsible for global deficits. Next, we further characterize the dysconnectivity of the deficient regions in terms of sub-network properties, and investigate their relevance with respect to clinical profiles. We define the subset of regions with decreased nodal integration (evaluated using the closeness centrality measure) as the affected core (A-core) of the 22q11DS structural connectome. A-core regions are broadly bilaterally symmetric and consist of numerous network hubs — chiefly parietal and frontal cortical, as well as subcortical regions. Using a simulated lesion approach, we demonstrate that these core regions and their connections are particularly important to efficient network communication. Moreover, these regions are generally densely connected, but less so in 22q11DS. These specific disturbances are associated to a rerouting of shortest network paths that circumvent the A-core in 22q11DS, “de-centralizing” the network. Finally, the efficiency and mean connectivity strength of an orbito-frontal/cingulate circuit, included in the affected regions, correlate negatively with the extent of negative symptoms in 22q11DS patients, revealing the clinical relevance of present findings. The identified A-core overlaps numerous regions previously identified as affected in 22q11DS as well as in schizophrenia, which approximately 30–40% of 22q11DS patients develop. Graph theory confirms reduced integration in 22q11.2 deletion syndrome (22q11DS). An “affected core” (A-core) of hub regions drives global integration deficits. The A-core is generally densely connected, but less so in 22q11DS. Shortest network paths are rerouted around the A-core in 22q11DS. Connectivity of a subset of A-core regions correlates with negative symptoms.
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Affiliation(s)
- František Váša
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Alessandra Griffa
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland; Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Elisa Scariati
- Office Médico-Pédagogique, Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Marie Schaer
- Office Médico-Pédagogique, Department of Psychiatry, University of Geneva, Geneva, Switzerland; Stanford Cognitive and Systems Neuroscience Laboratory, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Sébastien Urben
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent (SUPEA), Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland
| | - Stephan Eliez
- Office Médico-Pédagogique, Department of Psychiatry, University of Geneva, Geneva, Switzerland
| | - Patric Hagmann
- Department of Radiology, Lausanne University Hospital (CHUV) and University of Lausanne (UNIL), Lausanne, Switzerland; Signal Processing Laboratory (LTS5), Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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24
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Schmitt JE, Vandekar S, Yi J, Calkins ME, Ruparel K, Roalf DR, Whinna D, Souders MC, Satterwaite TD, Prabhakaran K, McDonald-McGinn DM, Zackai EH, Gur RC, Emanuel BS, Gur RE. Aberrant Cortical Morphometry in the 22q11.2 Deletion Syndrome. Biol Psychiatry 2015; 78:135-43. [PMID: 25555483 PMCID: PMC4446247 DOI: 10.1016/j.biopsych.2014.10.025] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 10/23/2014] [Accepted: 10/24/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND There is increased risk of developing psychosis in 22q11.2 deletion syndrome (22q11DS). Although this condition is associated with morphologic brain abnormalities, simultaneous examination of multiple high-resolution measures of cortical structure has not been performed. METHODS Fifty-three patients with 22q11DS, 30 with psychotic symptoms, were compared with demographically matched nondeleted youths: 53 typically developing and 53 with psychotic symptoms. High-resolution magnetic resonance imaging measures of cerebral volume, cortical thickness, surface area, and an index of local gyrification were obtained and compared between groups. RESULTS Patients with 22q11DS demonstrated global increases in cortical thickness associated with reductions in surface area, reduced index of local gyrification, and lower cerebral volumes relative to typically developing controls. Findings were principally in the frontal lobe, superior parietal lobes, and in the paramedian cerebral cortex. Focally decreased thickness was seen in the superior temporal gyrus and posterior cingulate cortex in 22q11DS relative to nondeleted groups. Patterns between nondeleted participants with psychotic symptoms and 22q11DS were similar but with important differences in several regions implicated in schizophrenia. Post hoc analysis suggested that like the 22q11DS group, cortical thickness in nondeleted individuals with psychotic symptoms differed from typically developing controls in the superior frontal gyrus and superior temporal gyrus, regions previously linked to schizophrenia. CONCLUSIONS Simultaneous examination of multiple measures of cerebral architecture demonstrates that differences in 22q11DS localize to regions of the frontal, superior parietal, superior temporal, and paramidline cerebral cortex. The overlapping patterns between nondeleted participants with psychotic symptoms and 22q11DS suggest partially shared neuroanatomic substrates.
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Affiliation(s)
- J. Eric Schmitt
- Brain Behavior Laboratory, Department of Psychiatry, Neuropsychiatry Section, University of Pennsylvania, Philadelphia, PA 19104, USA,Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Simon Vandekar
- Brain Behavior Laboratory, Department of Psychiatry, Neuropsychiatry Section, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - James Yi
- Brain Behavior Laboratory, Department of Psychiatry, Neuropsychiatry Section, University of Pennsylvania, Philadelphia, PA 19104, USA,Department of Child and Adolescent Psychiatry, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Monica E. Calkins
- Brain Behavior Laboratory, Department of Psychiatry, Neuropsychiatry Section, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Kosha Ruparel
- Brain Behavior Laboratory, Department of Psychiatry, Neuropsychiatry Section, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - David R. Roalf
- Brain Behavior Laboratory, Department of Psychiatry, Neuropsychiatry Section, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Daneen Whinna
- Brain Behavior Laboratory, Department of Psychiatry, Neuropsychiatry Section, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Margaret C. Souders
- Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Theodore D. Satterwaite
- Brain Behavior Laboratory, Department of Psychiatry, Neuropsychiatry Section, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Karthik Prabhakaran
- Brain Behavior Laboratory, Department of Psychiatry, Neuropsychiatry Section, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Elaine H. Zackai
- Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Ruben C. Gur
- Brain Behavior Laboratory, Department of Psychiatry, Neuropsychiatry Section, University of Pennsylvania, Philadelphia, PA 19104, USA,Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Beverly S. Emanuel
- Division of Human Genetics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Raquel E. Gur
- Brain Behavior Laboratory, Department of Psychiatry, Neuropsychiatry Section, University of Pennsylvania, Philadelphia, PA 19104, USA,Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA,Corresponding Author: Brain Behavior Laboratory, 10th Floor, Gates Building, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA. (R.E. Gur). Phone: (215) 662-2915, Fax: (215) 662-7903
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25
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Isobe M, Tanigaki K, Muraki K, Miyata J, Takemura A, Sugihara G, Takahashi H, Aso T, Fukuyama H, Hazama M, Murai T. Polymorphism within a Neuronal Activity-Dependent Enhancer of NgR1 Is Associated with Corpus Callosum Morphology in Humans. MOLECULAR NEUROPSYCHIATRY 2015; 1:105-15. [PMID: 27602360 DOI: 10.1159/000430463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 04/13/2015] [Indexed: 11/19/2022]
Abstract
The human Nogo-66 receptor 1 (NgR1) gene, also termed Nogo receptor 1 or reticulon 4 receptor (RTN4R) and located within 22q11.2, inhibits axonal growth and synaptic plasticity. Patients with the 22q11.2 deletion syndrome show multiple changes in brain morphology, with corpus callosum (CC) abnormalities being among the most prominent and frequently reported. Thus, we hypothesized that, in humans, NgR1 may be involved in CC formation. We focused on rs701428, a single nucleotide polymorphism of NgR1, which is associated with schizophrenia. We investigated the effects of the rs701428 genotype on CC structure in 50 healthy participants using magnetic resonance imaging. Polymorphism of rs701428 was associated with CC structural variation in healthy participants; specifically, minor A allele carriers had larger whole CC volumes and lower radial diffusivity in the central CC region compared with major G allele homozygous participants. Furthermore, we showed that the NgR1 3' region, which contains rs701428, is a neuronal activity-dependent enhancer, and that the minor A allele of rs701428 is susceptible to regulation of enhancer activity by MYBL2. Our results suggest that NgR1 can influence the macro- and microstructure of the white matter of the human brain.
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Affiliation(s)
- Masanori Isobe
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenji Tanigaki
- Shiga Medical Center Research Institute, Moriyama, Japan
| | - Kazue Muraki
- Shiga Medical Center Research Institute, Moriyama, Japan
| | - Jun Miyata
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ariyoshi Takemura
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Genichi Sugihara
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hidehiko Takahashi
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshihiko Aso
- Human Brain Research Center, Kyoto University, Kyoto, Japan
| | | | - Masaaki Hazama
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshiya Murai
- Department of Psychiatry, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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26
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General approach to velocardiofacial anomalies: a pediatric case presenting with Fallot tetralogy. North Clin Istanb 2015; 1:182-186. [PMID: 28058329 PMCID: PMC5175041 DOI: 10.14744/nci.2014.04695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 12/03/2014] [Indexed: 11/20/2022] Open
Abstract
Velocardiofacial syndrome (VCFS), also known as “Shprintzen syndrome” or “22q11.2 deletion syndrome” is an autosomal dominant genetic disorder with a wide range of phenotypical findings. It is majorly characterized by cleft palate, dysmorphic face, conotruncal cardiac anomalies, growth retardation, neurologic disorders and learning disabilities. Our case was the first child of her family and she had a cleft palate, dysmorphic face, tetralogy of Fallot (TOF), growth retardation and a mild neuromotor developmental delay. It is important to recognize this syndrome and inform the family about the probable future health problems of their babies as early as possible. Genetic counselling is crucial for the subsequent pregnancies. Therefore, we wanted to review the literature about the differential diagnosis and genetics of velocardiofacial anomalies.
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27
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Kates WR, Olszewski AK, Gnirke MH, Kikinis Z, Nelson J, Antshel KM, Fremont W, Radoeva PD, Middleton FA, Shenton ME, Coman IL. White matter microstructural abnormalities of the cingulum bundle in youths with 22q11.2 deletion syndrome: associations with medication, neuropsychological function, and prodromal symptoms of psychosis. Schizophr Res 2015; 161:76-84. [PMID: 25066496 PMCID: PMC4277733 DOI: 10.1016/j.schres.2014.07.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 07/02/2014] [Accepted: 07/03/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND The 22q11.2 deletion syndrome (22q11.2DS) is regarded as an etiologically homogenous model for understanding neuroanatomic disruptions associated with a high risk for schizophrenia. This study utilized diffusion tensor imaging (DTI) to analyze white matter microstructure in individuals with 22q11.2DS. We focused on the cingulum bundle (CB), previously shown to be disrupted in patients with schizophrenia and associated with symptoms of psychosis. METHODS White matter microstructure was assessed in the anterior, superior, and posterior CB using the tractography algorithm in DTIStudio. Neuropsychological function, presence of prodromal symptoms of psychosis, and medication history were assessed in all participants. RESULTS Relative to controls, young adults with 22q11.2DS showed alterations in most DTI metrics of the CB. Alterations were associated with positive prodromal symptoms of psychosis. However, when individuals with 22q11.2DS were divided by usage of antipsychotics/mood stabilizers, the medicated and non-medicated groups differed significantly in axial diffusivity of the anterior CB and in fractional anisotropy of the superior CB. DTI metrics did not differ between the medicated group and the control group. CONCLUSIONS Results suggest that the microstructure of the CB is altered in individuals with 22q11.2DS, and that those alterations may underlie positive prodromal symptoms of psychosis. Our findings further provide preliminary evidence that antipsychotic/mood stabilizer usage may have a reparative effect on white matter microstructure in prodromal 22q11.2DS, independent of the potential effects of psychosis. Future studies of white matter pathology in individuals with 22q11.2DS should test for potential effects of medication on white matter microstructure.
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Affiliation(s)
- Wendy R Kates
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, NY, United States.
| | - Amy K Olszewski
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, NY, United States
| | - Matthew H Gnirke
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, NY, United States
| | - Zora Kikinis
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Joshua Nelson
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, NY, United States
| | - Kevin M Antshel
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, NY, United States; Department of Psychology, Syracuse University, Syracuse, NY, United States
| | - Wanda Fremont
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, NY, United States
| | - Petya D Radoeva
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, NY, United States
| | - Frank A Middleton
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, NY, United States; Department of Neuroscience and Physiology, State University of New York at Upstate Medical University, Syracuse, NY, United States
| | - Martha E Shenton
- Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States; VA Boston Healthcare System, Brockton Division, Brockton, MA, United States
| | - Ioana L Coman
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, NY, United States
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Schmitt JE, Yi JJ, Roalf DR, Loevner LA, Ruparel K, Whinna D, Souders MC, McDonald-McGinn DM, Yodh E, Vandekar S, Zackai EH, Gur RC, Emanuel BS, Gur RE. Incidental radiologic findings in the 22q11.2 deletion syndrome. AJNR Am J Neuroradiol 2014; 35:2186-91. [PMID: 24948496 DOI: 10.3174/ajnr.a4003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND PURPOSE The 22q11.2 deletion syndrome is a common genetic microdeletion syndrome that results in cognitive delays and an increased risk of several psychiatric disorders, particularly schizophrenia. The current study investigates the prevalence of incidental neuroradiologic findings within this population and their relationships with psychiatric conditions. MATERIALS AND METHODS Brain MR imaging from 58 individuals with 22q11.2 deletion syndrome was reviewed by board-certified radiologists by using standard clinical procedures. Intracranial incidental findings were classified into 8 categories and compared with a large typically developing cohort. RESULTS The rate of incidental findings was significantly higher (P < .0001) in 22q11.2 deletion syndrome compared with typically developing individuals, driven by a high prevalence of cavum septum pellucidum (19.0%) and white matter abnormalities (10.3%). Both of these findings were associated with psychosis in 22q11.2 deletion syndrome. CONCLUSIONS Cavum septum pellucidum and white matter hyperintensities are significantly more prevalent in patients with the 22q11.2 deletion syndrome and may represent biomarkers for psychosis.
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Affiliation(s)
- J E Schmitt
- From the Department of Radiology (J.E.S., L.A.L.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania Brain Behavior Laboratory (J.E.S., J.J.Y., D.R.R., K.R., D.W., E.Y., S.V., R.C.G., R.E.G.), Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - J J Yi
- Brain Behavior Laboratory (J.E.S., J.J.Y., D.R.R., K.R., D.W., E.Y., S.V., R.C.G., R.E.G.), Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania Department of Psychiatry (J.J.Y.)
| | - D R Roalf
- Brain Behavior Laboratory (J.E.S., J.J.Y., D.R.R., K.R., D.W., E.Y., S.V., R.C.G., R.E.G.), Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - L A Loevner
- From the Department of Radiology (J.E.S., L.A.L.), Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - K Ruparel
- Brain Behavior Laboratory (J.E.S., J.J.Y., D.R.R., K.R., D.W., E.Y., S.V., R.C.G., R.E.G.), Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - D Whinna
- Brain Behavior Laboratory (J.E.S., J.J.Y., D.R.R., K.R., D.W., E.Y., S.V., R.C.G., R.E.G.), Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - M C Souders
- Division of Human Genetics (M.C.S., D.M.M.-M., E.H.Z., B.S.E.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - D M McDonald-McGinn
- Division of Human Genetics (M.C.S., D.M.M.-M., E.H.Z., B.S.E.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Pediatrics (D.M.M.-M., E.H.Z., B.S.E.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Department of Pediatrics (D.M.M.-M., E.H.Z., B.S.E.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - E Yodh
- Brain Behavior Laboratory (J.E.S., J.J.Y., D.R.R., K.R., D.W., E.Y., S.V., R.C.G., R.E.G.), Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - S Vandekar
- Brain Behavior Laboratory (J.E.S., J.J.Y., D.R.R., K.R., D.W., E.Y., S.V., R.C.G., R.E.G.), Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - E H Zackai
- Division of Human Genetics (M.C.S., D.M.M.-M., E.H.Z., B.S.E.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Pediatrics (D.M.M.-M., E.H.Z., B.S.E.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Department of Pediatrics (D.M.M.-M., E.H.Z., B.S.E.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - R C Gur
- Brain Behavior Laboratory (J.E.S., J.J.Y., D.R.R., K.R., D.W., E.Y., S.V., R.C.G., R.E.G.), Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - B S Emanuel
- Division of Human Genetics (M.C.S., D.M.M.-M., E.H.Z., B.S.E.), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania Department of Pediatrics (D.M.M.-M., E.H.Z., B.S.E.), University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Department of Pediatrics (D.M.M.-M., E.H.Z., B.S.E.), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - R E Gur
- Brain Behavior Laboratory (J.E.S., J.J.Y., D.R.R., K.R., D.W., E.Y., S.V., R.C.G., R.E.G.), Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
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Sellier C, Hwang VJ, Dandekar R, Durbin-Johnson B, Charlet-Berguerand N, Ander BP, Sharp FR, Angkustsiri K, Simon TJ, Tassone F. Decreased DGCR8 expression and miRNA dysregulation in individuals with 22q11.2 deletion syndrome. PLoS One 2014; 9:e103884. [PMID: 25084529 PMCID: PMC4118991 DOI: 10.1371/journal.pone.0103884] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Accepted: 07/08/2014] [Indexed: 11/30/2022] Open
Abstract
Deletion of the 1.5–3 Mb region of chromosome 22 at locus 11.2 gives rise to the chromosome 22q11.2 deletion syndrome (22q11DS), also known as DiGeorge and Velocardiofacial Syndromes. It is the most common micro-deletion disorder in humans and one of the most common multiple malformation syndromes. The syndrome is characterized by a broad phenotype, whose characterization has expanded considerably within the last decade and includes many associated findings such as craniofacial anomalies (40%), conotruncal defects of the heart (CHD; 70–80%), hypocalcemia (20–60%), and a range of neurocognitive anomalies with high risk of schizophrenia, all with a broad phenotypic variability. These phenotypic features are believed to be the result of a change in the copy number or dosage of the genes located in the deleted region. Despite this relatively clear genetic etiology, very little is known about which genes modulate phenotypic variations in humans or if they are due to combinatorial effects of reduced dosage of multiple genes acting in concert. Here, we report on decreased expression levels of genes within the deletion region of chromosome 22, including DGCR8, in peripheral leukocytes derived from individuals with 22q11DS compared to healthy controls. Furthermore, we found dysregulated miRNA expression in individuals with 22q11DS, including miR-150, miR-194 and miR-185. We postulate this to be related to DGCR8 haploinsufficiency as DGCR8 regulates miRNA biogenesis. Importantly we demonstrate that the level of some miRNAs correlates with brain measures, CHD and thyroid abnormalities, suggesting that the dysregulated miRNAs may contribute to these phenotypes and/or represent relevant blood biomarkers of the disease in individuals with 22q11DS.
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Affiliation(s)
- Chantal Sellier
- Institute of Genetics and Molecular and Cellular Biology, University of Strasbourg, Strasbourg, France
| | - Vicki J. Hwang
- Department of Biochemistry and Molecular Medicine, University of California Davis, Sacramento, California, United States of America
| | - Ravi Dandekar
- Department of Biochemistry and Molecular Medicine, University of California Davis, Sacramento, California, United States of America
| | - Blythe Durbin-Johnson
- Department of Public Health Sciences, UC Davis Medical Center, Sacramento, California, United States of America
| | | | - Bradley P. Ander
- MIND Institute, UC Davis Medical Center, Sacramento, California, United States of America
- Department of Neurology, UC Davis Medical Center, Sacramento, California, United States of America
| | - Frank R. Sharp
- MIND Institute, UC Davis Medical Center, Sacramento, California, United States of America
- Department of Neurology, UC Davis Medical Center, Sacramento, California, United States of America
| | - Kathleen Angkustsiri
- MIND Institute, UC Davis Medical Center, Sacramento, California, United States of America
- Department of Pediatrics, UC Davis Medical Center, Sacramento, California, United States of America
| | - Tony J. Simon
- MIND Institute, UC Davis Medical Center, Sacramento, California, United States of America
- Department of Psychiatry, UC Davis Medical Center, Sacramento, California, United States of America
| | - Flora Tassone
- Department of Biochemistry and Molecular Medicine, University of California Davis, Sacramento, California, United States of America
- MIND Institute, UC Davis Medical Center, Sacramento, California, United States of America
- * E-mail:
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Scariati E, Schaer M, Richiardi J, Schneider M, Debbané M, Van De Ville D, Eliez S. Identifying 22q11.2 Deletion Syndrome and Psychosis Using Resting-State Connectivity Patterns. Brain Topogr 2014; 27:808-21. [DOI: 10.1007/s10548-014-0356-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 02/12/2014] [Indexed: 11/30/2022]
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Montojo C, Ibrahim A, Karlsgodt K, Chow C, Hilton A, Jonas R, Vesagas T, Bearden C. Disrupted working memory circuitry and psychotic symptoms in 22q11.2 deletion syndrome. Neuroimage Clin 2014; 4:392-402. [PMID: 24567911 PMCID: PMC3930118 DOI: 10.1016/j.nicl.2014.01.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 01/18/2014] [Accepted: 01/21/2014] [Indexed: 11/30/2022]
Abstract
22q11.2 deletion syndrome (22q11DS) is a recurrent genetic mutation that is highly penetrant for psychosis. Behavioral research suggests that 22q11DS patients exhibit a characteristic neurocognitive phenotype that includes differential impairment in spatial working memory (WM). Notably, spatial WM has also been proposed as an endophenotype for idiopathic psychotic disorder, yet little is known about the neurobiological substrates of WM in 22q11DS. In order to investigate the neural systems engaged during spatial WM in 22q11DS patients, we collected functional magnetic resonance imaging (fMRI) data while 41 participants (16 22q11DS patients, 25 demographically matched controls) performed a spatial capacity WM task that included manipulations of delay length and load level. Relative to controls, 22q11DS patients showed reduced neural activation during task performance in the intraparietal sulcus (IPS) and superior frontal sulcus (SFS). In addition, the typical increases in neural activity within spatial WM-relevant regions with greater memory load were not observed in 22q11DS. We further investigated whether neural dysfunction during WM was associated with behavioral WM performance, assessed via the University of Maryland letter-number sequencing (LNS) task, and positive psychotic symptoms, assessed via the Structured Interview for Prodromal Syndromes (SIPS), in 22q11DS patients. WM load activity within IPS and SFS was positively correlated with LNS task performance; moreover, WM load activity within IPS was inversely correlated with the severity of unusual thought content and delusional ideas, indicating that decreased recruitment of working memory-associated neural circuitry is associated with more severe positive symptoms. These results suggest that 22q11DS patients show reduced neural recruitment of brain regions critical for spatial WM function, which may be related to characteristic behavioral manifestations of the disorder.
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Affiliation(s)
- C.A. Montojo
- Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Psychology, 1285 Franz Hall, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - A. Ibrahim
- Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - K.H. Karlsgodt
- Feinstein Institute for Medical Research, Zucker Hillside Hospital, North Shore-LIJ Health System, 350 Community Drive, Manhasset, NY 11030, USA
| | - C. Chow
- Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - A.E. Hilton
- Department of Psychology, 1285 Franz Hall, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - R.K. Jonas
- Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - T.K. Vesagas
- Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - C.E. Bearden
- Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Department of Psychology, 1285 Franz Hall, University of California, Los Angeles, Los Angeles, CA 90095, USA
- Brain Research Institute, 695 Charles E Young Drive S, University of California, Los Angeles, Los Angeles, CA 90095, USA
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Ellegood J, Markx S, Lerch J, Steadman P, Genç C, Provenzano F, Kushner S, Henkelman R, Karayiorgou M, Gogos J. Neuroanatomical phenotypes in a mouse model of the 22q11.2 microdeletion. Mol Psychiatry 2014; 19:99-107. [PMID: 23999526 PMCID: PMC3872255 DOI: 10.1038/mp.2013.112] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 07/21/2013] [Accepted: 07/22/2013] [Indexed: 12/21/2022]
Abstract
Recurrent deletions at the 22q11.2 locus have been established as a strong genetic risk factor for the development of schizophrenia and cognitive dysfunction. Individuals with 22q11.2 deletions have a range of well-defined volumetric abnormalities in a number of critical brain structures. A mouse model of the 22q11.2 deletion (Df(16)A(+/-)) has previously been utilized to characterize disease-associated abnormalities on synaptic, cellular, neurocircuitry, and behavioral levels. We performed a high-resolution MRI analysis of mutant mice compared with wild-type littermates. Our analysis revealed a striking similarity in the specific volumetric changes of Df(16)A(+/-) mice compared with human 22q11.2 deletion carriers, including in cortico-cerebellar, cortico-striatal and cortico-limbic circuits. In addition, higher resolution magnetic resonance imaging compared with neuroimaging in human subjects allowed the detection of previously unknown subtle local differences. The cerebellar findings in Df(16)A(+/-) mice are particularly instructive as they are localized to specific areas within both the deep cerebellar nuclei and the cerebellar cortex. Our study indicates that the Df(16)A(+/-)mouse model recapitulates most of the hallmark neuroanatomical changes observed in 22q11.2 deletion carriers. Our findings will help guide the design and interpretation of additional complementary studies and thereby advance our understanding of the abnormal brain development underlying the emergence of 22q11.2 deletion-associated psychiatric and cognitive symptoms.
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Affiliation(s)
- J. Ellegood
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - S. Markx
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - J.P. Lerch
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada
,Department of Medical Biophysics, University of Toronto, Toronto, Ontario Canada
| | - P.E. Steadman
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada
,Department of Medical Biophysics, University of Toronto, Toronto, Ontario Canada
| | - C. Genç
- Department of Psychiatry, Erasmus Medical Center, The Netherlands
| | - F Provenzano
- Department of Department of Biomedical Engineering, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - S.A. Kushner
- Department of Psychiatry, Erasmus Medical Center, The Netherlands
| | - R.M. Henkelman
- Mouse Imaging Centre, Hospital for Sick Children, Toronto, Ontario, Canada
,Department of Medical Biophysics, University of Toronto, Toronto, Ontario Canada
| | - M. Karayiorgou
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - J.A. Gogos
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA
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Schreiner MJ, Lazaro MT, Jalbrzikowski M, Bearden CE. Converging levels of analysis on a genomic hotspot for psychosis: insights from 22q11.2 deletion syndrome. Neuropharmacology 2013; 68:157-73. [PMID: 23098994 PMCID: PMC3677073 DOI: 10.1016/j.neuropharm.2012.09.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 09/04/2012] [Accepted: 09/17/2012] [Indexed: 10/27/2022]
Abstract
Schizophrenia is a devastating neurodevelopmental disorder that, despite extensive research, still poses a considerable challenge to attempts to unravel its heterogeneity, and the complex biochemical mechanisms by which it arises. While the majority of cases are of unknown etiology, accumulating evidence suggests that rare genetic mutations, such as 22q11.2 Deletion Syndrome (22qDS), can play a significant role in predisposition to the illness. Up to 25% of individuals with 22qDS eventually develop schizophrenia; conversely, this deletion is estimated to account for 1-2% of schizophrenia cases overall. This locus of Chromosome 22q11.2 contains genes that encode for proteins and enzymes involved in regulating neurotransmission, neuronal development, myelination, microRNA processing, and post-translational protein modifications. As a consequence of the deletion, affected individuals exhibit cognitive dysfunction, structural and functional brain abnormalities, and neurodevelopmental anomalies that parallel many of the phenotypic characteristics of schizophrenia. As an illustration of the value of rare, highly penetrant genetic subtypes for elucidating pathological mechanisms of complex neuropsychiatric disorders, we provide here an overview of the cellular, network, and systems-level anomalies found in 22qDS, and review the intriguing evidence for this disorder's association with schizophrenia. This article is part of the Special Issue entitled 'Neurodevelopmental Disorders'.
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Affiliation(s)
- Matthew J. Schreiner
- Interdepartmental Neuroscience Program, University of California, Los Angeles, USA
| | - Maria T. Lazaro
- Interdepartmental Neuroscience Program, University of California, Los Angeles, USA
| | | | - Carrie E. Bearden
- Department of Psychology, University of California, Los Angeles, USA
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, USA
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Villalon-Reina J, Jahanshad N, Beaton E, Toga AW, Thompson PM, Simon TJ. White matter microstructural abnormalities in girls with chromosome 22q11.2 deletion syndrome, Fragile X or Turner syndrome as evidenced by diffusion tensor imaging. Neuroimage 2013; 81:441-454. [PMID: 23602925 DOI: 10.1016/j.neuroimage.2013.04.028] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 04/03/2013] [Accepted: 04/10/2013] [Indexed: 12/19/2022] Open
Abstract
Children with chromosome 22q11.2 deletion syndrome (22q11.2DS), Fragile X syndrome (FXS), or Turner syndrome (TS) are considered to belong to distinct genetic groups, as each disorder is caused by separate genetic alterations. Even so, they have similar cognitive and behavioral dysfunctions, particularly in visuospatial and numerical abilities. To assess evidence for common underlying neural microstructural alterations, we set out to determine whether these groups have partially overlapping white matter abnormalities, relative to typically developing controls. We scanned 101 female children between 7 and 14years old: 25 with 22q11.2DS, 18 with FXS, 17 with TS, and 41 aged-matched controls using diffusion tensor imaging (DTI). Anisotropy and diffusivity measures were calculated and all brain scans were nonlinearly aligned to population and site-specific templates. We performed voxel-based statistical comparisons of the DTI-derived metrics between each disease group and the controls, while adjusting for age. Girls with 22q11.2DS showed lower fractional anisotropy (FA) than controls in the association fibers of the superior and inferior longitudinal fasciculi, the splenium of the corpus callosum, and the corticospinal tract. FA was abnormally lower in girls with FXS in the posterior limbs of the internal capsule, posterior thalami, and precentral gyrus. Girls with TS had lower FA in the inferior longitudinal fasciculus, right internal capsule and left cerebellar peduncle. Partially overlapping neurodevelopmental anomalies were detected in all three neurogenetic disorders. Altered white matter integrity in the superior and inferior longitudinal fasciculi and thalamic to frontal tracts may contribute to the behavioral characteristics of all of these disorders.
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Affiliation(s)
- Julio Villalon-Reina
- Imaging Genetics Center, Laboratory of Neuro Imaging, Dept. of Neurology, University of California Los Angeles, School of Medicine, Los Angeles, CA 90095, USA
| | - Neda Jahanshad
- Imaging Genetics Center, Laboratory of Neuro Imaging, Dept. of Neurology, University of California Los Angeles, School of Medicine, Los Angeles, CA 90095, USA
| | - Elliott Beaton
- Stress, Cognition, and Affective Neuroscience Laboratory, Department of Psychology, University of New Orleans, New Orleans, LA, 70148
| | - Arthur W Toga
- Laboratory of Neuro Imaging, Dept. of Neurology, University of California Los Angeles, School of Medicine, Los Angeles, CA 90095, USA
| | - Paul M Thompson
- Imaging Genetics Center, Laboratory of Neuro Imaging, Dept. of Neurology, University of California Los Angeles, School of Medicine, Los Angeles, CA 90095, USA.
| | - Tony J Simon
- Dept. of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, 95618, USA; MIND Institute, Dept. of Psychiatry and Behavioral Sciences, University of California, Davis, Sacramento, CA, 95618, USA
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Sinderberry B, Brown S, Hammond P, Stevens AF, Schall U, Murphy DGM, Murphy KC, Campbell LE. Subtypes in 22q11.2 deletion syndrome associated with behaviour and neurofacial morphology. RESEARCH IN DEVELOPMENTAL DISABILITIES 2013; 34:116-125. [PMID: 22940165 DOI: 10.1016/j.ridd.2012.07.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 07/24/2012] [Accepted: 07/24/2012] [Indexed: 06/01/2023]
Abstract
22q11.2 deletion syndrome (22q11DS) has a complex phenotype with more than 180 characteristics, including cardiac anomalies, cleft palate, intellectual disabilities, a typical facial morphology, and mental health problems. However, the variable phenotype makes it difficult to predict clinical outcome, such as the high prevalence of psychosis among adults with 22q11DS (~25-30% vs. ~1% in the general population). The purpose of this study was to investigate whether subtypes exist among people with 22q11DS, with a similar phenotype and an increased risk of developing mental health problems. Physical, cognitive and behavioural data from 50 children and adolescents with 22q11DS were included in a k-means cluster analysis. Two distinct phenotypes were identified: Type-1 presented with a more severe phenotype including significantly impaired verbal memory, lower intellectual and academic ability, as well as statistically significant reduced total brain volume. In addition, we identified a trend effect for reduced temporal grey matter. Type-1 also presented with autism-spectrum traits, whereas Type-2 could be described as having more 22q11DS-typical face morphology, being predominately affected by executive function deficits, but otherwise being relatively high functioning with regard to cognition and behaviour. The confirmation of well-defined subtypes in 22q11DS can lead to better prognostic information enabling early identification of people with 22q11DS at high risk of psychiatric disorders. The identification of subtypes in a group of people with a relatively homogenous genetic deletion such as 22q11DS is also valuable to understand clinical outcomes.
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Affiliation(s)
- Brooke Sinderberry
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia.
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Animal models of psychiatric disorders that reflect human copy number variation. Neural Plast 2012; 2012:589524. [PMID: 22900207 PMCID: PMC3414062 DOI: 10.1155/2012/589524] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 06/11/2012] [Accepted: 06/13/2012] [Indexed: 12/04/2022] Open
Abstract
The development of genetic technologies has led to the identification of several copy number variations (CNVs) in the human genome. Genome rearrangements affect dosage-sensitive gene expression in normal brain development. There is strong evidence associating human psychiatric disorders, especially autism spectrum disorders (ASDs) and schizophrenia to genetic risk factors and accumulated CNV risk loci. Deletions in 1q21, 3q29, 15q13, 17p12, and 22q11, as well as duplications in 16p11, 16p13, and 15q11-13 have been reported as recurrent CNVs in ASD and/or schizophrenia. Chromosome engineering can be a useful technology to reflect human diseases in animal models, especially CNV-based psychiatric disorders. This system, based on the Cre/loxP strategy, uses large chromosome rearrangement such as deletion, duplication, inversion, and translocation. Although it is hard to reflect human pathophysiology in animal models, some aspects of molecular pathways, brain anatomy, cognitive, and behavioral phenotypes can be addressed. Some groups have created animal models of psychiatric disorders, ASD, and schizophrenia, which are based on human CNV. These mouse models display some brain anatomical and behavioral abnormalities, providing insight into human neuropsychiatric disorders that will contribute to novel drug screening for these devastating disorders.
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Kunwar A, Ramanathan S, Nelson J, Antshel KM, Fremont W, Higgins AM, Shprintzen RJ, Kates WR. Cortical gyrification in velo-cardio-facial (22q11.2 deletion) syndrome: a longitudinal study. Schizophr Res 2012; 137:20-5. [PMID: 22365148 PMCID: PMC3414250 DOI: 10.1016/j.schres.2012.01.032] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2011] [Revised: 01/21/2012] [Accepted: 01/24/2012] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Velo-cardio-facial syndrome (VCFS) has been identified as an important risk factor for psychoses, with up to 32% of individuals with VCFS developing a psychotic illness. Individuals with VCFS thus form a unique group to identify and explore early symptoms and biological correlates of psychosis. In this study, we examined if cortical gyrification pattern, i.e. gyrification index (GI) can be a potential neurobiological marker for psychosis. METHOD GIs of 91 individuals with VCFS were compared with 29 siblings and 54 controls. Further, 58 participants with VCFS, 21 siblings and 18 normal controls were followed up after 3 years and longitudinal changes in GI were compared. Additionally, we also correlated longitudinal changes in GI in individuals with VCFS with prodromal symptoms of psychosis on the Scale of Prodromal Symptoms (SOPS). RESULT Individuals with VCFS had significantly lower GIs as compared to their siblings and normal controls. Longitudinal examination of GI did not reveal any significant group-time interactions between the three groups. Further, longitudinal change in GI scores in the VCFS group was negatively correlated with positive prodromal symptoms, with the left occipital region reaching statistical significance. CONCLUSION The study confirms previous reports that individuals with VCFS have reduced cortical folding as compared to normal controls. However over a period of three years, there is no difference in the rate of change of GI among both individuals with VCFS and normal controls. Finally, our results suggest that neuroanatomical alterations in areas underlying visual processing may be an early marker for psychosis.
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Affiliation(s)
- Arun Kunwar
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, New York
| | - Seethalakshmi Ramanathan
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, New York
| | - Joshua Nelson
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, New York
| | - Kevin M. Antshel
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, New York
| | - Wanda Fremont
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, New York
| | - Anne Marie Higgins
- Department of Otolaryngology, State University of New York at Upstate Medical University, Syracuse, New York
| | | | - Wendy R. Kates
- Department of Psychiatry and Behavioral Sciences, State University of New York at Upstate Medical University, Syracuse, New York
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van Beveren NJM, Krab LC, Swagemakers S, Buitendijk G, Buitendijk GHS, Boot E, van der Spek P, Elgersma Y, van Amelsvoort TAMJ. Functional gene-expression analysis shows involvement of schizophrenia-relevant pathways in patients with 22q11 deletion syndrome. PLoS One 2012; 7:e33473. [PMID: 22457764 PMCID: PMC3310870 DOI: 10.1371/journal.pone.0033473] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 02/09/2012] [Indexed: 12/19/2022] Open
Abstract
22q11 Deletion Syndrome (22q11DS) is associated with dysmorphology and a high prevalence of schizophrenia-like symptoms. Several genes located on chromosome 22q11 have been linked to schizophrenia. The deletion is thought to disrupt the expression of multiple genes involved in maturation and development of neurons and neuronal circuits, and neurotransmission. We investigated whole-genome gene expression of Peripheral Blood Mononuclear Cells (PBMC's) of 8 22q11DS patients and 8 age- and gender-matched controls, to (1) investigate the expression levels of 22q11 genes and (2) to investigate whether 22q11 genes participate in functional genetic networks relevant to schizophrenia. Functional relationships between genes differentially expressed in patients (as identified by Locally Adaptive Statistical procedure (LAP) or satisfying p<0.05 and fold-change >1.5) were investigated with the Ingenuity Pathways Analysis (IPA). 14 samples (7 patients, 7 controls) passed quality controls. LAP identified 29 deregulated genes. Pathway analysis showed 262 transcripts differentially expressed between patients and controls. Functional pathways most disturbed were cell death, cell morphology, cellular assembly and organization, and cell-to-cell signaling. In addition, 10 canonical pathways were identified, among which the signal pathways for Natural Killer-cells, neurotrophin/Trk, neuregulin, axonal guidance, and Huntington's disease. Our findings support the use of 22q11DS as a research model for schizophrenia. We identified decreased expression of several genes (among which COMT, Ufd1L, PCQAP, and GNB1L) previously linked to schizophrenia as well as involvement of signaling pathways relevant to schizophrenia, of which Neurotrophin/Trk and neuregulin signaling seems to be especially notable.
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Affiliation(s)
- Nico J M van Beveren
- Department of Psychiatry, Erasmus University Medical Centre, Rotterdam, The Netherlands.
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A cross-sectional study of the development of volitional control of spatial attention in children with chromosome 22q11.2 deletion syndrome. J Neurodev Disord 2012; 4:5. [PMID: 22958432 PMCID: PMC3374293 DOI: 10.1186/1866-1955-4-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 02/15/2012] [Indexed: 11/10/2022] Open
Abstract
Background Chromosome 22q11.2 deletion syndrome (22q11.2DS) results from a 1.5- to 3-megabase deletion on the long arm of chromosome 22 and occurs in approximately 1 in 4000 live births. Previous studies indicate that children with 22q11.2DS are impaired on tasks involving spatial attention. However, the degree to which these impairments are due to volitionally generated (endogenous) or reflexive (exogenous) orienting of attention is unclear. Additionally, the efficacy of these component attention processes throughout child development in 22q11.2DS has yet to be examined. Methods Here we compared the performance of a wide age range (7 to 14 years) of children with 22q11.2DS to typically developing (TD) children on a comprehensive visual cueing paradigm to dissociate the contributions of endogenous and exogenous attentional impairments. Paired and two-sample t-tests were used to compare outcome measures within a group or between groups. Additionally, repeated measures regression models were fit to the data in order to examine effects of age on performance. Results We found that children with 22q11.2DS were impaired on a cueing task with an endogenous cue, but not on the same task with an exogenous cue. Additionally, it was younger children exclusively who were impaired on endogenous cueing when compared to age-matched TD children. Older children with 22q11.2DS performed comparably to age-matched TD peers on the endogenous cueing task. Conclusions These results suggest that endogenous but not exogenous orienting of attention is selectively impaired in children with 22q11.2DS. Additionally, the age effect on cueing in children with 22q11.2DS suggests a possible altered developmental trajectory of endogenous cueing.
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Minor physical anomalies in patients with bipolar I disorder and normal controls. J Affect Disord 2011; 135:193-200. [PMID: 21846578 DOI: 10.1016/j.jad.2011.07.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 07/19/2011] [Accepted: 07/19/2011] [Indexed: 02/02/2023]
Abstract
BACKGROUND The neurodevelopmental hypothesis is well established in schizophrenia but has received modest empirical support in bipolar disorder. In schizophrenia it is partly based on the higher prevalence of minor physical anomalies (MPAs), established by many well controlled studies. No studies with comparable designs have been performed in bipolar disorder. The present study aims to establish the rate and topographic distribution of MPAs in bipolar I patients. METHODS The subjects were 61 patients (25 men, 36 women) with bipolar I disorder and 103 normal subjects (49 men, 54 women) who were examined for MPAs using a modified version of the Waldrop Physical Anomaly Scale. RESULTS The bipolar I patients showed significantly higher regional MPA scores in 3 distinct regions - mouth, feet and head, as well as in the overall scores for the craniofacial complex, the periphery and the total MPA score. Differences were statistically significant for 3 anomalies - high/steepled palate, big gap between I and II toes and furrowed tongue that made significant contribution to the prediction of the patient-control status in a discriminant analysis model. CONCLUSIONS Our data suggest that aberrant processes of neurodevelopment may contribute to the etiology of bipolar I disorder. The field is open for further research using modern instruments and designs in order to identify potential biological markers for bipolar disorder.
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Magnée MJCM, Lamme VAF, de Sain-van der Velden MGM, Vorstman JAS, Kemner C. Proline and COMT status affect visual connectivity in children with 22q11.2 deletion syndrome. PLoS One 2011; 6:e25882. [PMID: 21998713 PMCID: PMC3187802 DOI: 10.1371/journal.pone.0025882] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2011] [Accepted: 09/12/2011] [Indexed: 11/17/2022] Open
Abstract
Background Individuals with the 22q11.2 deletion syndrome (22q11DS) are at increased risk for schizophrenia and Autism Spectrum Disorders (ASDs). Given the prevalence of visual processing deficits in these three disorders, a causal relationship between genes in the deleted region of chromosome 22 and visual processing is likely. Therefore, 22q11DS may represent a unique model to understand the neurobiology of visual processing deficits related with ASD and psychosis. Methodology We measured Event-Related Potentials (ERPs) during a texture segregation task in 58 children with 22q11DS and 100 age-matched controls. The C1 component was used to index afferent activity of visual cortex area V1; the texture negativity wave provided a measure for the integrity of recurrent connections in the visual cortical system. COMT genotype and plasma proline levels were assessed in 22q11DS individuals. Principal Findings Children with 22q11DS showed enhanced feedforward activity starting from 70 ms after visual presentation. ERP activity related to visual feedback activity was reduced in the 22q11DS group, which was seen as less texture negativity around 150 ms post presentation. Within the 22q11DS group we further demonstrated an association between high plasma proline levels and aberrant feedback/feedforward ratios, which was moderated by the COMT158 genotype. Conclusions These findings confirm the presence of early visual processing deficits in 22q11DS. We discuss these in terms of dysfunctional synaptic plasticity in early visual processing areas, possibly associated with deviant dopaminergic and glutamatergic transmission. As such, our findings may serve as a promising biomarker related to the development of schizophrenia among 22q11DS individuals.
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Affiliation(s)
- Maurice J C M Magnée
- Rudolf Magnus Institute of Neuroscience, Department of Child and Adolescent Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands.
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Murphy CM, Deeley Q, Daly E, Ecker C, O'Brien F, Hallahan B, Loth E, Toal F, Reed S, Hales S, Robertson D, Craig M, Mullins D, Barker G, Lavender T, Johnston P, Murphy K, Murphy D. Anatomy and aging of the amygdala and hippocampus in autism spectrum disorder: an in vivo magnetic resonance imaging study of Asperger syndrome. Autism Res 2011; 5:3-12. [DOI: 10.1002/aur.227] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 07/20/2011] [Indexed: 11/08/2022]
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Vicari S, Mantovan M, Addona F, Costanzo F, Verucci L, Menghini D. Neuropsychological Profile of Italian Children and Adolescents with 22q11.2 Deletion Syndrome with and Without Intellectual Disability. Behav Genet 2011; 42:287-98. [DOI: 10.1007/s10519-011-9499-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Accepted: 08/16/2011] [Indexed: 10/17/2022]
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Campbell LE, Stevens AF, McCabe K, Cruickshank L, Morris RG, Murphy DGM, Murphy KC. Is theory of mind related to social dysfunction and emotional problems in 22q11.2 deletion syndrome (velo-cardio-facial syndrome)? J Neurodev Disord 2011; 3:152-61. [PMID: 21544568 PMCID: PMC3188292 DOI: 10.1007/s11689-011-9082-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2010] [Accepted: 04/05/2011] [Indexed: 10/24/2022] Open
Abstract
Social dysfunction is intrinsically involved in severe psychiatric disorders such as depression and psychosis and linked with poor theory of mind. Children with 22q11.2 deletion syndrome (22q11DS, or velo-cardio-facial syndrome) have poor social competence and are also at a particularly high risk of developing mood (40%) and psychotic (up to 30%) disorders in adolescence and young adulthood. However, it is unknown if these problems are associated with theory of mind skills, including underlying social-cognitive and social-perceptual mechanisms. The present cross-sectional study included classic social-cognitive false-belief and mentalising tasks and social-perceptual face processing tasks. The performance of 50 children with 22q11DS was compared with 31 age-matched typically developing sibling controls. Key findings indicated that, while younger children with 22q11DS showed impaired acquisition of social-cognitive skills, older children with 22q11DS were not significantly impaired compared with sibling controls. However, children with 22q11DS were found to have social-perceptual deficits, as demonstrated by difficulties in matching faces on the basis of identity, emotion, facial speech and gaze compared with sibling controls. Furthermore, performance on the tasks was associated with age, language ability and parentally rated social competence and emotional problems. These results are discussed in relation to the importance of a better delineation of social competence in this population.
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Affiliation(s)
- Linda E Campbell
- Institute of Psychiatry, King's College London, University of London, London, UK,
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Drew LJ, Crabtree GW, Markx S, Stark KL, Chaverneff F, Xu B, Mukai J, Fenelon K, Hsu PK, Gogos JA, Karayiorgou M. The 22q11.2 microdeletion: fifteen years of insights into the genetic and neural complexity of psychiatric disorders. Int J Dev Neurosci 2011; 29:259-81. [PMID: 20920576 PMCID: PMC3074020 DOI: 10.1016/j.ijdevneu.2010.09.007] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Revised: 09/17/2010] [Accepted: 09/20/2010] [Indexed: 12/22/2022] Open
Abstract
Over the last fifteen years it has become established that 22q11.2 deletion syndrome (22q11DS) is a true genetic risk factor for schizophrenia. Carriers of deletions in chromosome 22q11.2 develop schizophrenia at rate of 25-30% and such deletions account for as many as 1-2% of cases of sporadic schizophrenia in the general population. Access to a relatively homogeneous population of individuals that suffer from schizophrenia as the result of a shared etiological factor and the potential to generate etiologically valid mouse models provides an immense opportunity to better understand the pathobiology of this disease. In this review we survey the clinical literature associated with the 22q11.2 microdeletions with a focus on neuroanatomical changes. Then, we highlight results from work modeling this structural mutation in animals. The key biological pathways disrupted by the mutation are discussed and how these changes impact the structure and function of neural circuits is described.
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Affiliation(s)
- Liam J. Drew
- Department of Physiology and Cellular Biophysics, Columbia University, New York, New York 10032, USA
| | - Gregg W. Crabtree
- Department of Physiology and Cellular Biophysics, Columbia University, New York, New York 10032, USA
| | - Sander Markx
- Department of Psychiatry, Columbia University, New York, New York 10032, USA
| | - Kimberly L. Stark
- Department of Physiology and Cellular Biophysics, Columbia University, New York, New York 10032, USA
- Department of Psychiatry, Columbia University, New York, New York 10032, USA
| | - Florence Chaverneff
- Department of Physiology and Cellular Biophysics, Columbia University, New York, New York 10032, USA
| | - Bin Xu
- Department of Physiology and Cellular Biophysics, Columbia University, New York, New York 10032, USA
- Department of Psychiatry, Columbia University, New York, New York 10032, USA
| | - Jun Mukai
- Department of Physiology and Cellular Biophysics, Columbia University, New York, New York 10032, USA
| | - Karine Fenelon
- Department of Physiology and Cellular Biophysics, Columbia University, New York, New York 10032, USA
| | - Pei-Ken Hsu
- Department of Physiology and Cellular Biophysics, Columbia University, New York, New York 10032, USA
- Integrated Program in Cellular, Molecular, and Biophysical Studies, Columbia University, New York, New York 10032, USA
| | - Joseph A. Gogos
- Department of Physiology and Cellular Biophysics, Columbia University, New York, New York 10032, USA
- Department of Neuroscience, College of Physicians and Surgeons, Columbia University, New York, New York 10032, USA
| | - Maria Karayiorgou
- Department of Psychiatry, Columbia University, New York, New York 10032, USA
- New York State Psychiatric Institute, New York, New York 10032, USA
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Paul LK. Developmental malformation of the corpus callosum: a review of typical callosal development and examples of developmental disorders with callosal involvement. J Neurodev Disord 2011; 3:3-27. [PMID: 21484594 PMCID: PMC3163989 DOI: 10.1007/s11689-010-9059-y] [Citation(s) in RCA: 155] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 08/13/2010] [Indexed: 12/11/2022] Open
Abstract
This review provides an overview of the involvement of the corpus callosum (CC) in a variety of developmental disorders that are currently defined exclusively by genetics, developmental insult, and/or behavior. I begin with a general review of CC development, connectivity, and function, followed by discussion of the research methods typically utilized to study the callosum. The bulk of the review concentrates on specific developmental disorders, beginning with agenesis of the corpus callosum (AgCC)-the only condition diagnosed exclusively by callosal anatomy. This is followed by a review of several genetic disorders that commonly result in social impairments and/or psychopathology similar to AgCC (neurofibromatosis-1, Turner syndrome, 22q11.2 deletion syndrome, Williams yndrome, and fragile X) and two forms of prenatal injury (premature birth, fetal alcohol syndrome) known to impact callosal development. Finally, I examine callosal involvement in several common developmental disorders defined exclusively by behavioral patterns (developmental language delay, dyslexia, attention-deficit hyperactive disorder, autism spectrum disorders, and Tourette syndrome).
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Affiliation(s)
- Lynn K Paul
- Division of Humanities and Social Sciences, California Institute of Technology, HSS 228-77, Caltech, Pasadena, CA, 91125, USA,
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Baker K, Chaddock CA, Baldeweg T, Skuse D. Neuroanatomy in adolescents and young adults with 22q11 Deletion Syndrome: Comparison to an IQ-matched group. Neuroimage 2011; 55:491-9. [DOI: 10.1016/j.neuroimage.2010.12.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 12/11/2010] [Accepted: 12/14/2010] [Indexed: 02/07/2023] Open
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Hallahan BP, Craig MC, Toal F, Daly EM, Moore CJ, Ambikapathy A, Robertson D, Murphy KC, Murphy DG. In vivo brain anatomy of adult males with Fragile X syndrome: An MRI study. Neuroimage 2011; 54:16-24. [DOI: 10.1016/j.neuroimage.2010.08.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Revised: 08/04/2010] [Accepted: 08/06/2010] [Indexed: 10/19/2022] Open
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Beaton EA, Simon TJ. How might stress contribute to increased risk for schizophrenia in children with chromosome 22q11.2 deletion syndrome? J Neurodev Disord 2010; 3:68-75. [PMID: 21475728 PMCID: PMC3056992 DOI: 10.1007/s11689-010-9069-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 11/26/2010] [Indexed: 01/19/2023] Open
Abstract
The most common human microdeletion occurs at chromosome 22q11.2. The associated syndrome (22q11.2DS) has a complex and variable phenotype with a high risk of schizophrenia. While the role of stress in the etiopathology of schizophrenia has been under investigation for over 30 years (Walker et al. 2008), the stress–diathesis model has yet to be investigated in children with 22q11.2DS. Children with 22q11.2DS face serious medical, behavioral, and socioemotional challenges from infancy into adulthood. Chronic stress elevates glucocorticoids, decreases immunocompetence, negatively impacts brain development and function, and is associated with psychiatric illness in adulthood. Drawing knowledge from the extant and well-developed anxiety and stress literature will provide invaluable insight into the complex etiopathology of schizophrenia in people with 22q11.2DS while suggesting possible early interventions. Childhood anxiety is treatable and stress coping skills can be developed thereby improving quality of life in the short-term and potentially mitigating the risk of developing psychosis.
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Affiliation(s)
- Elliott A Beaton
- Department of Psychiatry and Behavioral Sciences and the M.I.N.D. Institute, University of California Davis, 2825 50th Street, Sacramento, CA 95817 USA
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Mølsted K, Boers M, Kjaer I. The morphology of the sella turcica in velocardiofacial syndrome suggests involvement of a neural crest developmental field. Am J Med Genet A 2010; 152A:1450-7. [PMID: 20503320 DOI: 10.1002/ajmg.a.33381] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We described the morphology of the sella turcica in individuals with velocardiofacial syndrome (VCFS), also known as chromosome 22q11.2 deletion syndrome, and compared the morphology with that of a control group of individuals from the Oslo University Craniofacial Growth Archive. The aim was to measure the cranial base angles in individuals with VCFS and, if possible, to discover the developmental field that may be involved in the condition. The study included 33 patients with VCFS from the Copenhagen Cleft Palate Center, Denmark. The genotype was confirmed by fluorescence in situ hybridization. The morphology of the sella turcica was described and measurements of the cranial base angles were performed on lateral cephalometric radiographs. The VCFS individuals had larger deviations in the morphology of the sella turcica compared to individuals from the Oslo University Craniofacial Growth archive. The deviations were mostly in the posterior part of the dorsum sellae. Individuals with VCFS had increased cranial base angles. The results of this study combined with the information in the literature on the main defects in VCFS (palatal abnormalities, cardiac anomalies, thymic hypoplasia or aplasia, hypothyroidism, and posterior brain abnormality), suggest involvement of a specific developmental field.
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Affiliation(s)
- Kirsten Mølsted
- Copenhagen Cleft Palate Centre, University Hospital of Copenhagen, Hellerup, Denmark.
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